Pennsylvania Sole Custody Agreement
PENNSYLVANIA SOLE CUSTODY AGREEMENT
Stipulation for Sole Legal Custody and Sole Physical Custody with Partial/Supervised Physical Custody to Non-Custodial Parent
Filed Pursuant to 23 Pa.C.S. Chapter 53 (Pennsylvania Child Custody Act)
PENNSYLVANIA SOLE CUSTODY — STATUTORY CONTEXT
Under 23 Pa.C.S. § 5322(a), Pennsylvania defines sole custody as follows:
- Sole legal custody — the right of one individual to exclusive legal custody of the child, including exclusive authority to make major decisions regarding the child's education, medical care, religious upbringing, and welfare.
- Sole physical custody — the right of one individual to exclusive physical custody of the child.
The non-custodial parent may be awarded:
- Partial physical custody — the right to assume physical custody of the child for less than a majority of the time.
- Supervised physical custody — custodial time during which an agency or adult designated by the court or agreed upon by the parties monitors the interaction between the child and the individual with those rights. Pennsylvania further distinguishes between:
- Nonprofessional supervised physical custody — monitored by an adult designated by the court or agreed upon by the parties.
- Professional supervised physical custody — monitored by a professional with education and training on the dynamics of domestic violence, sexual assault, child abuse, trauma, and the impact of domestic violence on children.
The court awards sole custody only when it determines, after considering all 16 best interest factors under 23 Pa.C.S. § 5328(a), that sole custody serves the child's best interests. Sole custody does not terminate the non-custodial parent's right to information access or to seek modification.
1. COURT AND CASE INFORMATION
Court of Common Pleas of [________________________________] County, Pennsylvania
Family Division
Docket Number: [________________________________]
Case Caption: [________________________________] v. [________________________________]
1.1 Parties
Custodial Parent (Plaintiff/Defendant):
Full Legal Name: [________________________________]
Address: [________________________________]
City, State, ZIP: [________________________________]
Telephone: [________________________________]
Email: [________________________________]
Non-Custodial Parent (Plaintiff/Defendant):
Full Legal Name: [________________________________]
Address: [________________________________]
City, State, ZIP: [________________________________]
Telephone: [________________________________]
Email: [________________________________]
1.2 Minor Child(ren)
| Child's Full Legal Name | Date of Birth | Age | Current School / Grade |
|---|---|---|---|
| [________________________________] | [__/__/____] | [____] | [________________________________] |
| [________________________________] | [__/__/____] | [____] | [________________________________] |
(Each individually a "Child" and collectively the "Children.")
1.3 Nature of Proceeding
☐ Divorce action (23 Pa.C.S. § 3301)
☐ Custody complaint (23 Pa.C.S. § 5321)
☐ Petition for modification (23 Pa.C.S. § 5338)
☐ Paternity / parentage action
☐ Other: [________________________________]
1.4 Effective Date
This Agreement shall become effective as of [__/__/____], or upon the date of the Court's order incorporating this Agreement, whichever is later.
1.5 Criminal Record / Abuse History Verification (Pa.R.C.P. 1915.3-2)
Each party has filed the required verification regarding criminal record or abuse history pursuant to Pa.R.C.P. 1915.3-2 and 23 Pa.C.S. § 5329.
☐ Neither party has a criminal record or abuse history requiring disclosure under § 5329.
☐ The Non-Custodial Parent has disclosed the following: [________________________________]
☐ The Custodial Parent has disclosed the following: [________________________________]
☐ The Court has considered the disclosures and determined that the award below is in the Children's best interest and does not pose a threat of harm per 23 Pa.C.S. § 5329(a).
1.6 Basis for Sole Custody
The Parents agree that sole legal and sole physical custody with the Custodial Parent serves the Children's best interests for the following reasons:
☐ History of domestic violence or abuse (23 Pa.C.S. § 5329)
☐ Substance abuse by Non-Custodial Parent
☐ Incarceration of Non-Custodial Parent
☐ Geographic distance making shared custody impractical
☐ Non-Custodial Parent's inability to cooperate in shared decision-making
☐ Non-Custodial Parent's mental health condition affecting custodial fitness
☐ Non-Custodial Parent's extended absence or abandonment
☐ Other: [________________________________]
2. BEST INTEREST ANALYSIS UNDER 23 Pa.C.S. § 5328(a)
The Parents acknowledge that the Court must consider the following 16 factors. The Parents' positions on each factor are as follows:
(1) Party more likely to encourage and permit frequent and continuing contact: [________________________________]
(2) Present and past abuse by a party or household member: ☐ No history ☐ History: [________________________________]
(2.1) Child abuse and involvement with protective services (§ 5329.1(a)): ☐ None ☐ Involvement: [________________________________]
(2.2) Violent or assaultive behavior: ☐ None ☐ History: [________________________________]
(3) Parental duties performed by each party: [________________________________]
(4) Need for stability and continuity in child's education, family life, and community life: [________________________________]
(5) Availability of extended family: [________________________________]
(6) Sibling relationships: ☐ All Children remain together ☐ Other: [________________________________]
(7) Well-reasoned preference of child, based on maturity and judgment (§ 5328(a)(7)): ☐ Not applicable ☐ Child has expressed preference: [________________________________]
(8) Attempts to turn child against other parent: [________________________________]
(9) Party more likely to maintain loving, stable, consistent, nurturing relationship: [________________________________]
(10) Party more likely to attend to daily physical, emotional, developmental, educational, and special needs: [________________________________]
(11) Proximity of residences: [________________________________]
(12) Availability to care for child or make appropriate arrangements: [________________________________]
(13) Level of conflict between parties; willingness to cooperate: [________________________________]
(14) History of drug or alcohol abuse: ☐ None ☐ History: [________________________________]
(15) Mental and physical condition of parties and household members: [________________________________]
(16) Any other relevant factor: [________________________________]
3. SOLE LEGAL CUSTODY
3.1 Grant of Sole Legal Custody
The Custodial Parent is awarded sole legal custody of the Children as defined by 23 Pa.C.S. § 5322(a). The Custodial Parent shall have the exclusive right and responsibility to make all major decisions regarding the Children, including:
(a) Education — school enrollment, school changes, special education evaluations and services (IEP/Section 504), tutoring, and childcare/daycare;
(b) Medical Care — selection of physicians, dentists, and specialists; authorization of non-emergency medical procedures; medications; and orthodontic treatment;
(c) Mental Health — initiation of counseling, therapy, psychiatric evaluation, and psychotropic medication;
(d) Religious Upbringing — religious instruction, ceremonies, and regular observance;
(e) Extracurricular Activities — enrollment in sports, clubs, lessons, and camps;
(f) Travel — authorization of out-of-state and international travel;
(g) Legal Matters — any legal action taken on behalf of the Children.
3.2 Courtesy Notification to Non-Custodial Parent
Although not required for decision-making authority, the Custodial Parent:
☐ Shall provide reasonable advance notice to the Non-Custodial Parent of major decisions when practicable
☐ May, but is not required to, consult with the Non-Custodial Parent
3.3 Emergency Decisions
The Custodial Parent or any person exercising physical custody at the time of an emergency may make any decision necessary to protect the Children's health or safety. The Non-Custodial Parent shall be notified as soon as reasonably possible.
4. SOLE PHYSICAL CUSTODY AND NON-CUSTODIAL PARENT'S CUSTODIAL TIME
4.1 Grant of Sole Physical Custody
The Custodial Parent is awarded sole physical custody. The Children shall reside primarily at:
Address: [________________________________]
School District: [________________________________]
School Name: [________________________________]
4.2 Non-Custodial Parent's Custodial Time
Select the applicable arrangement:
☐ Option A: Partial Physical Custody — Standard Schedule
The Non-Custodial Parent is awarded partial physical custody as defined by 23 Pa.C.S. § 5322(a) (less than a majority of time) on the following schedule:
- Alternating Weekends: Every other weekend from Friday at [____] PM to Sunday at [____] PM
-
Midweek Period: Every [________________________________] from [____] PM to [____] PM
☐ With overnight ☐ Dinner visit only (return by [____] PM) -
Extended Summer: [____] non-consecutive weeks during summer with [____] days' advance written notice
☐ Option B: Partial Physical Custody — Expanded Schedule
- Alternating Weekends: Every other weekend from Friday after school to Monday morning school drop-off
- Midweek Periods: Two periods per week: [________________________________] and [________________________________] from [____] PM to [____] PM
- Extended Summer: [____] weeks during summer (consecutive or split) with [____] days' advance written notice
☐ Option C: Supervised Physical Custody
Supervised physical custody is awarded pursuant to 23 Pa.C.S. § 5322(a) under the following terms:
-
Type of Supervision:
☐ Professional supervised physical custody — at approved supervised visitation facility: [________________________________]
☐ Nonprofessional supervised physical custody — in the presence of: [________________________________] (approved supervisor) -
Schedule: [________________________________] from [____] to [____]
- Duration: [____] hours per visit, [____] visits per [week/month]
-
Conditions for Continued Supervision:
☐ Completion of substance abuse treatment
☐ Completion of anger management program
☐ Completion of parenting education program
☐ Clean drug/alcohol test results for [____] consecutive months
☐ Mental health evaluation and compliance with treatment recommendations
☐ Compliance with Protection from Abuse (PFA) order
☐ Other: [________________________________] -
Review of Supervision: The supervision requirement shall be reviewed:
☐ In [____] months from the date of this order
☐ Upon completion of the conditions listed above
☐ Upon petition by either party -
Transition to Unsupervised Custody: Upon satisfactory completion of the conditions above and court approval, the Non-Custodial Parent's custody may be modified to unsupervised partial physical custody under the following graduated schedule:
Phase 1 ([____] months): Unsupervised daytime visits of [____] hours, [____] times per week
Phase 2 ([____] months): Unsupervised visits including one overnight per weekend
Phase 3: Standard partial physical custody schedule per Option A above
☐ Option D: Custom Schedule
[________________________________]
4.3 Exchange Location and Transportation
Exchange Location:
☐ School
☐ Custodial Parent's residence (curbside)
☐ Neutral public location: [________________________________]
☐ Supervised exchange facility: [________________________________]
☐ Other: [________________________________]
Transportation:
☐ Non-Custodial Parent responsible for pick-up and return
☐ Custodial Parent delivers; Non-Custodial Parent returns
☐ Shared equally
☐ Other: [________________________________]
4.4 Holiday Schedule
Holidays supersede the regular schedule.
| Holiday | Even Years | Odd Years | Time Period |
|---|---|---|---|
| New Year's Day | Parent [____] | Parent [____] | Dec. 31 [____] PM - Jan. 1 [____] PM |
| Easter / Passover | Parent [____] | Parent [____] | [________________________________] |
| Memorial Day Weekend | Parent [____] | Parent [____] | Sat. [____] AM - Mon. [____] PM |
| Fourth of July | Parent [____] | Parent [____] | Jul. 3 [____] PM - Jul. 5 [____] AM |
| Labor Day Weekend | Parent [____] | Parent [____] | Sat. [____] AM - Mon. [____] PM |
| Thanksgiving | Parent [____] | Parent [____] | Wed. [____] PM - Sun. [____] PM |
| Winter Break - First Half | Parent [____] | Parent [____] | Last school day [____] PM - Dec. 25 [____] PM |
| Winter Break - Second Half | Parent [____] | Parent [____] | Dec. 25 [____] PM - day before school [____] PM |
| Mother's Day | With Mother | With Mother | Sat. [____] AM - Sun. [____] PM |
| Father's Day | With Father | With Father | Sat. [____] AM - Sun. [____] PM |
| Child's Birthday | Parent [____] | Parent [____] | [________________________________] |
5. COMMUNICATION AND INFORMATION ACCESS
5.1 Parent-Child Communication
The Custodial Parent shall facilitate reasonable communication between the Non-Custodial Parent and the Children:
☐ Daily phone/video calls at approximately [____] PM for up to [____] minutes
☐ Phone/video calls on [________________________________] at [____] PM
☐ As mutually agreed at reasonable times
The Custodial Parent shall not monitor, record, or interfere with the Children's communication with the Non-Custodial Parent, except as reasonably necessary for young children.
5.2 Between Parents
Parents shall communicate regarding the Children through:
☐ OurFamilyWizard ☐ TalkingParents ☐ Email ☐ Text message ☐ Other: [________________________________]
5.3 Non-Custodial Parent's Right to Information
The Non-Custodial Parent retains the right to access the following directly from the source, regardless of the sole custody designation:
(a) School records, report cards, and progress reports;
(b) Medical, dental, and mental health records;
(c) Notification of school events and extracurricular activities;
(d) Both Parents shall be listed as parents and emergency contacts on all school and medical records.
The Custodial Parent shall:
(a) Provide copies of report cards and significant medical information within [____] days of receipt;
(b) Notify the Non-Custodial Parent of any emergency, serious illness, injury, or hospitalization within [____] hours;
(c) Notify the Non-Custodial Parent of school events and parent-teacher conferences with sufficient advance notice.
5.4 Non-Disparagement
(a) Neither Parent shall make negative or disparaging remarks about the other Parent in the Children's presence or hearing.
(b) Neither Parent shall discuss court proceedings or adult matters with the Children.
(c) Neither Parent shall use the Children as messengers.
6. RESTRICTIONS AND COVENANTS
6.1 Substance Use Restrictions
(a) Neither Parent shall use controlled substances (except as lawfully prescribed) during custodial time or within [____] hours before custodial time begins.
(b) Neither Parent shall consume alcohol to the point of impairment during custodial time.
(c) ☐ The Non-Custodial Parent shall submit to random drug/alcohol testing at the request of the Custodial Parent, at the Non-Custodial Parent's expense. [Use only if court-ordered or agreed.]
6.2 Firearms Safety
All firearms shall be stored unloaded in a locked container with ammunition stored separately, inaccessible to the Children, in compliance with 18 Pa.C.S. § 6108.
6.3 Non-Interference
The Non-Custodial Parent shall not interfere with the Custodial Parent's decision-making authority or the Children's primary residence.
6.4 Return of Children
The Non-Custodial Parent shall return the Children to the Custodial Parent at the scheduled time and location. Late returns without reasonable notice and excuse constitute a material breach subject to contempt under 23 Pa.C.S. § 5323(g).
6.5 No Parental Alienation
Neither Parent shall engage in conduct designed to alienate the Children from the other Parent or undermine the parent-child relationship.
6.6 Protection from Abuse Order Compliance
☐ Not applicable.
☐ A Protection from Abuse (PFA) order is in effect. Case No.: [________________________________]. The Non-Custodial Parent shall comply with all terms of the PFA order. This Agreement does not modify the PFA order; to the extent of any conflict, the PFA order controls.
6.7 Conditions Specific to Non-Custodial Parent
☐ The Non-Custodial Parent shall maintain compliance with the following conditions as a prerequisite to exercising custodial time:
☐ Completion of and continued participation in substance abuse treatment
☐ Compliance with probation or parole conditions
☐ Maintenance of stable housing
☐ Continued mental health treatment
☐ Completion of parenting education program approved by [________________________________] County
☐ Other: [________________________________]
7. RELOCATION (23 Pa.C.S. § 5337)
7.1 Custodial Parent Relocation
The Custodial Parent proposing to relocate with the Children shall comply with the notice requirements of 23 Pa.C.S. § 5337(c):
(a) Written notice by certified mail, return receipt requested, no later than the 60th day before the proposed relocation;
(b) Notice shall include: the new address; names and ages of individuals in the new residence; telephone numbers; date of relocation; reasons; proposed revised custody schedule; information about the right to object; a counter-affidavit form (Pa.R.C.P. 1915.17); and a warning that failure to file a counter-affidavit within 30 days may allow approval of the relocation;
(c) The Non-Custodial Parent may object by filing a counter-affidavit within 30 days.
7.2 Court Determination
If the Non-Custodial Parent objects, the court shall consider the 10 relocation factors under 23 Pa.C.S. § 5337(h) in addition to the 16 best interest factors under § 5328(a). The Custodial Parent bears the burden of establishing that the relocation serves the Children's best interest. 23 Pa.C.S. § 5337(i).
7.3 Non-Custodial Parent Relocation
If the Non-Custodial Parent relocates such that the current partial physical custody schedule becomes impracticable, either party may petition for modification under 23 Pa.C.S. § 5338.
8. DISPUTE RESOLUTION
8.1 Direct Communication
Parents shall first attempt to resolve disputes regarding the Non-Custodial Parent's custodial time through direct, respectful communication.
8.2 Mediation
If direct communication fails, Parents shall participate in mediation with a qualified family mediator before seeking court intervention, except in emergencies or matters involving alleged abuse.
Cost allocation: ☐ Equal ☐ Non-Custodial Parent pays ☐ Other: [________________________________]
8.3 Court Proceedings (Pa.R.C.P. 1915.4)
If mediation fails, either Parent may file a petition with the Court of Common Pleas, Family Division, of [________________________________] County. Pursuant to Pa.R.C.P. 1915.4, the court shall schedule an initial conference or conciliation within 45 days.
Philadelphia County: Custody matters are filed at the Family Court Division, 1501 Arch Street, 11th Floor, Philadelphia, PA 19102.
8.4 Governing Law and Forum
This Agreement is governed by 23 Pa.C.S. Chapter 53 and Pa.R.C.P. 1915.1 et seq. The Court of Common Pleas, Family Division, of [________________________________] County retains exclusive, continuing jurisdiction under the UCCJEA (23 Pa.C.S. Chapter 54).
8.5 Contempt and Enforcement (23 Pa.C.S. § 5323(g))
Willful violation of any custody order may result in:
(a) Imprisonment for up to six months;
(b) A fine;
(c) Probation for up to six months;
(d) Suspension or denial of operating privilege under 23 Pa.C.S. § 4355;
(e) Make-up custodial time;
(f) Assessment of attorney's fees and costs.
9. HEALTH INSURANCE AND FINANCIAL PROVISIONS
9.1 Health Insurance
[________________________________] (Custodial Parent / Non-Custodial Parent / Both) shall maintain comprehensive health, dental, and vision insurance for the Children.
9.2 Unreimbursed Medical Expenses
Unreimbursed medical expenses shall be allocated:
☐ 100% to the Custodial Parent
☐ Equally (50/50)
☐ Pro rata based on income: Custodial Parent [____]% / Non-Custodial Parent [____]%
☐ Other: [________________________________]
9.3 Child Support
☐ Child support is addressed in a separate order.
☐ Child support is addressed concurrently.
10. MODIFICATION (23 Pa.C.S. § 5338)
10.1 Modification Standard
This Agreement, once incorporated as a court order, may be modified based on the 16 best interest factors of 23 Pa.C.S. § 5328(a). Any petition for modification must be accompanied by a criminal record / abuse history verification under Pa.R.C.P. 1915.3-2.
10.2 Transition from Sole to Shared Custody
Either Parent may petition the Court for modification from sole custody to shared custody if circumstances warrant, including but not limited to:
(a) Resolution of the conditions that necessitated the sole custody arrangement;
(b) Completion of required treatment programs;
(c) Demonstrated ability to cooperate in shared decision-making;
(d) The child's maturity and expressed preferences under § 5328(a)(7).
11. GENERAL PROVISIONS
11.1 Integration
This Agreement constitutes the entire understanding regarding custody and supersedes all prior agreements.
11.2 Severability
If any provision is unenforceable, the remaining provisions continue in full force.
11.3 Amendment
Modification requires written agreement of both Parents with Court approval, or Court order following a hearing.
11.4 Counterparts and Electronic Signatures
This Agreement may be executed in counterparts and by electronic signature.
12. EXECUTION
IN WITNESS WHEREOF, the Parents have executed this Agreement as of the date(s) below.
CUSTODIAL PARENT:
Signature: _________________________________
Print Name: [________________________________]
Date: [__/__/____]
NON-CUSTODIAL PARENT:
Signature: _________________________________
Print Name: [________________________________]
Date: [__/__/____]
ATTORNEY FOR CUSTODIAL PARENT (if applicable):
Signature: _________________________________
Print Name: [________________________________]
PA Supreme Court ID No.: [________________________________]
Date: [__/__/____]
ATTORNEY FOR NON-CUSTODIAL PARENT (if applicable):
Signature: _________________________________
Print Name: [________________________________]
PA Supreme Court ID No.: [________________________________]
Date: [__/__/____]
13. ORDER OF COURT
IN THE COURT OF COMMON PLEAS OF [________________________________] COUNTY, PENNSYLVANIA
FAMILY DIVISION
The Court, having reviewed the foregoing Stipulation for Sole Legal Custody and Sole Physical Custody, having considered all 16 best interest factors under 23 Pa.C.S. § 5328(a), the criminal record / abuse history disclosures under 23 Pa.C.S. § 5329 and Pa.R.C.P. 1915.3-2, and finding that the proposed arrangement serves the best interests of the minor child(ren):
IT IS HEREBY ORDERED that:
-
Sole legal custody and sole physical custody of the minor child(ren) are awarded to [________________________________] (Custodial Parent).
-
[________________________________] (Non-Custodial Parent) is awarded:
☐ Partial physical custody as set forth in Section 4.2, Option [____].
☐ Supervised physical custody as set forth in Section 4.2, Option C.
☐ Custom schedule as set forth in Section 4.2, Option D. -
Willful failure to comply with this Order may result in contempt sanctions under 23 Pa.C.S. § 5323(g).
Date: [__/__/____]
_________________________________
Judge, Court of Common Pleas
[________________________________] County, Pennsylvania
Sources and References
Pennsylvania Child Custody Act
- 23 Pa.C.S. Chapter 53 — Child Custody: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053..HTM
- 23 Pa.C.S. § 5322 — Custody Types: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053.022.000..HTM
- 23 Pa.C.S. § 5323 — Award of Custody; Contempt: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053.023.000..HTM
- 23 Pa.C.S. § 5328 — Best Interest Factors: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053.028.000..HTM
- 23 Pa.C.S. § 5329 — Criminal Record Consideration: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053.029.000..HTM
- 23 Pa.C.S. § 5337 — Relocation: https://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/23/00.053.037.000..HTM
Pennsylvania Rules of Civil Procedure
- Pa.R.C.P. 1915.1 et seq. — Custody Actions: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/231/chapter1915/chap1915toc.html
- Pa.R.C.P. 1915.3-2 — Criminal Record or Abuse History: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/231/chapter1915/s1915.3-2.html
Additional Resources
- Understanding Criminal Records in PA Custody Cases: https://www.pafamilylawllc.com/child-custody-and-criminal-record
- PA Unified Judicial System — Custody Proceedings: https://www.pacourts.us/learn/representing-yourself/custody-proceedings
Prepared for attorney review. This template is provided for informational purposes only and does not constitute legal advice.
About This Template
Family law covers the paperwork that shapes divorce, custody, child support, adoption, guardianship, and other family matters. These filings are emotional and high-stakes, and they also have to meet strict procedural rules for service, financial disclosure, and parenting plans. Clean, accurate paperwork keeps the focus on getting a workable outcome for the family instead of getting derailed by technical problems that delay hearings or force amended filings.
Important Notice
This template is provided for informational purposes. It is not legal advice. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Last updated: May 2026