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2. CASE NO.
4. Plaintiff Name
5. Complaining Party

   1. Yes
   2. No
7. Plaintiff Address
9. City
10. State
11. Zip Code
13. Defendant Name
14. Complaining Party

    1. Yes
    2. No
16. Defendant Address
18. City
19. State
20. Zip Code
22. PLEASE NOTE:

    1. The Friend of the Court will only enforce parenting time as provided in your order.

    2. Any verbal agreements between the parties will NOT be enforced.

    3. Include any dates or times relevant to the alleged denied parenting time.

    4. Parenting time complaints must be submitted within 56 days of the alleged violation.

    5. This form must be completed in full and signed by the complaining party.

    6. You may attach a separate sheet if further explanation is necessary.

24. I say that I was to have parenting time with:
26. Child's Name
27. Birthdate
    Birthdate
29. Child's Name
30. Birthdate
    Birthdate
32. Child's Name
33. Birthdate
    Birthdate
35. Beginning at:
    Beginning at:
36. On:
    On:
37. Until:
    Until:
38. On:
    On:
40. I was denied parenting time because:
42. Did you actually go to the home and attempt to pick up the child(ren)?

    1. Yes

    1. No
44. If your complaint is other than denial of parenting time, please explain:
46. Have you been denied parenting time before?

    1. Yes

    1. No
48. Are you requesting make up parenting time?

    1. Yes

    1. No
50. Proposed make up dates:
    Proposed make up dates: Start Date

    —

    Proposed make up dates: End Date
51. Additional proposed make up dates:
    Additional proposed make up dates: Start Date

    —

    Additional proposed make up dates: End Date
53. Please upload any additional documentation.
55. VBC-0540 (8/28/20)
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

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