Stipulation for Sole Parental Rights and Responsibilities with Parent-Child Contact - Vermont

Vermont Family Law Updated April 7, 2026 Free Word and PDF

STIPULATION FOR SOLE PARENTAL RIGHTS AND RESPONSIBILITIES

WITH PARENT-CHILD CONTACT ORDER

State of Vermont
Superior Court — Family Division

[________________________________] Unit


Docket No.: [________________________________]

Filed in connection with:
☐ Divorce (V.R.F.P. 4)
☐ Legal Separation
☐ Parentage Action
☐ Standalone PR&R Petition
☐ Civil Union Dissolution

[________________________________], Custodial Parent (Parent with sole PR&R)
[________________________________], Non-Custodial Parent (Parent with contact rights)


VERMONT TERMINOLOGY: Vermont law uses "parental rights and responsibilities" (PR&R) rather than "custody." Under 15 V.S.A. § 665(a), when parents cannot agree to share PR&R, the court shall award PR&R primarily or solely to one parent. This stipulation allocates sole legal and primary physical responsibility to one parent while establishing parent-child contact for the other parent. The term "parent-child contact" replaces "visitation" in Vermont practice.


PART I — PARTIES AND CHILDREN

1.1 Parents

Custodial Parent (Sole PR&R):

  • Full Name: [________________________________]
  • Address: [________________________________], Vermont [____]
  • County: [________________________________]
  • Telephone: [________________________________]
  • Email: [________________________________]

Non-Custodial Parent (Contact Rights):

  • Full Name: [________________________________]
  • Address: [________________________________]
  • County/State: [________________________________]
  • Telephone: [________________________________]
  • Email: [________________________________]

1.2 Children

Child's Full Legal Name Date of Birth Age Current School
[________________________________] [__/__/____] [____] [________________________________]
[________________________________] [__/__/____] [____] [________________________________]

1.3 Basis for Sole PR&R

The parties agree, or the court has determined, that sole PR&R to the Custodial Parent serves the child(ren)'s best interests due to:

☐ Geographic distance between parents makes shared PR&R impracticable
☐ History of inability to cooperate and communicate effectively regarding the child(ren) (factor 8 under § 665(b))
☐ Concerns regarding the Non-Custodial Parent's ability to provide a safe environment
☐ History of domestic violence or abuse as defined in 15 V.S.A. § 1101
☐ Substance abuse concerns
☐ Non-Custodial Parent's prolonged absence or limited involvement
☐ Other: [________________________________]

1.4 COPE Program Compliance

☐ Both parents have completed the mandatory COPE (Coping with Separation and Divorce) seminar administered by UVM Extension.
☐ The Non-Custodial Parent has been unable to complete COPE due to [________________________________] and requests a waiver or extension.


PART II — SOLE LEGAL RESPONSIBILITY

2.1 Grant of Sole Legal Responsibility

The Custodial Parent shall have sole legal responsibility for the child(ren) under 15 V.S.A. § 664. The Custodial Parent has exclusive authority to make all major decisions concerning the child(ren)'s welfare, including:

(a) Education: School enrollment, school changes, homeschooling, special education services, tutoring, and college planning.

(b) Medical care: Selection of physicians, dentists, and specialists; authorization of medical procedures; medications; and vaccinations.

(c) Mental health: Counseling, therapy, and psychiatric services.

(d) Religious upbringing: Religious education, ceremonies, and practices.

(e) Extracurricular activities: Sports, arts, clubs, and other activities.

(f) Travel: Authorization for domestic and international travel.

(g) Legal matters: Representation in legal proceedings; passport applications; name changes.

2.2 Informing the Non-Custodial Parent

The Custodial Parent shall:

☐ Inform the Non-Custodial Parent of major decisions within [____] days after the decision is made. The Non-Custodial Parent may express concerns but does not have veto authority.

☐ Make reasonable efforts to consult with the Non-Custodial Parent before major decisions, though the Custodial Parent retains final authority.

☐ Not be required to consult or inform the Non-Custodial Parent regarding major decisions. (Use only in cases of domestic violence, abuse, or extreme circumstances.)

2.3 Emergency Decisions

Either parent may make emergency medical or safety decisions when the child(ren) are in that parent's care. The other parent shall be notified as soon as practicable, and in all events within 24 hours.


PART III — PRIMARY PHYSICAL RESPONSIBILITY

3.1 Primary Residence

The child(ren) shall reside primarily with the Custodial Parent at:

[________________________________]
[________________________________], Vermont [____]

The child(ren) shall be enrolled in [________________________________] (school/school district).

3.2 Custodial Parent's Authority

The Custodial Parent has sole authority over the child(ren)'s day-to-day care, including routines, discipline, meals, bedtimes, homework supervision, childcare arrangements, and daily activities.


PART IV — NON-CUSTODIAL PARENT-CHILD CONTACT SCHEDULE

4.1 Type of Contact

☐ Standard unsupervised contact (Section 4.2)
☐ Expanded unsupervised contact (Section 4.3)
☐ Supervised contact (Section 4.4)
☐ Graduated/step-up contact (Section 4.5)

4.2 Standard Unsupervised Contact Schedule

Regular schedule:

  • Alternating weekends: Friday at [____] through Sunday at [____]
  • Midweek: [________________________________] (day) from [____] to [____]
    ☐ With overnight ☐ Without overnight

Approximate annual overnights: [____]

4.3 Expanded Unsupervised Contact Schedule

Regular schedule:

  • Alternating weekends: Friday at [____] through Monday morning (school drop-off)
  • Midweek: [________________________________] and [________________________________] (two evenings) from [____] to [____]
    ☐ With overnights ☐ Without overnights

Approximate annual overnights: [____]

4.4 Supervised Contact Schedule

(Applicable when the court or parties have determined supervision is necessary under 15 V.S.A. § 665a or based on safety concerns.)

Schedule:

  • [________________________________] (day(s)) from [____] to [____]
  • Frequency: ☐ Weekly ☐ Biweekly ☐ Other: [________________________________]
  • Duration per visit: [____] hours

Supervision arrangements:

☐ Professional supervised visitation center: [________________________________]
(Vermont-based centers include programs in Chittenden, Washington, and Rutland counties.)

☐ Approved individual supervisor: [________________________________]
Relationship to family: [________________________________]
Contact information: [________________________________]

☐ Therapeutic supervision by licensed clinician: [________________________________]

Conditions of supervised contact:

☐ The Non-Custodial Parent shall not consume alcohol or controlled substances within 24 hours preceding contact (per 15 V.S.A. § 665a).
☐ The Non-Custodial Parent shall submit to random drug/alcohol testing: [________________________________]
☐ The supervisor shall have authority to terminate any visit if the child(ren)'s safety is at risk.
☐ The Non-Custodial Parent shall bear the cost of supervision.
☐ Other conditions: [________________________________]

Review of supervision: The parties agree to review the need for supervision every [____] months. Modification to unsupervised contact requires:
☐ Agreement of both parties filed with the court
☐ Court order following a motion and hearing
☐ Completion of the following conditions: [________________________________]

4.5 Graduated (Step-Up) Contact Schedule

(For situations where contact is being reintroduced or expanded gradually.)

Phase 1 (Weeks 1–[____]):
[________________________________]

Phase 2 (Weeks [____]–[____]):
[________________________________]

Phase 3 (Weeks [____]–[____]):
[________________________________]

Phase 4 — Ongoing:
[________________________________]

Progression to each phase requires: [________________________________]

4.6 Holiday Schedule

Holiday / Break Even Years Odd Years Times
New Year's Day [________________________________] [________________________________] [________________________________]
Town Meeting Day [________________________________] [________________________________] [________________________________]
Spring Break [________________________________] [________________________________] [________________________________]
Memorial Day Weekend [________________________________] [________________________________] [________________________________]
Independence Day [________________________________] [________________________________] [________________________________]
Bennington Battle Day [________________________________] [________________________________] [________________________________]
Labor Day Weekend [________________________________] [________________________________] [________________________________]
Thanksgiving Break [________________________________] [________________________________] [________________________________]
Winter Break — First Half [________________________________] [________________________________] [________________________________]
Winter Break — Second Half [________________________________] [________________________________] [________________________________]
Mother's Day With Mother With Mother 9 AM – 7 PM
Father's Day With Father With Father 9 AM – 7 PM
Child's Birthday [________________________________] [________________________________] [________________________________]

Holiday contact supersedes the regular schedule.

4.7 Summer Contact

The Non-Custodial Parent shall have [____] weeks of summer contact with at least [____] days' advance written notice to the Custodial Parent. Summer contact requests shall be submitted by April 1 each year.

☐ Summer weeks may be consecutive.
☐ Summer weeks must be non-consecutive.
☐ Summer contact shall not conflict with the child(ren)'s enrolled summer programs: [________________________________]

4.8 Exchanges

  • Exchange location: [________________________________]
    ☐ Custodial Parent's residence
    ☐ Neutral public location: [________________________________]
    ☐ School / childcare
    ☐ Other: [________________________________]

  • Transportation: [________________________________]
    ☐ Non-Custodial Parent provides all transportation
    ☐ Custodial Parent provides all transportation
    ☐ Shared (Non-Custodial Parent picks up; Custodial Parent picks up for return)
    ☐ Other: [________________________________]

  • Late policy: Notification required if more than 15 minutes late. If the Non-Custodial Parent is more than [____] minutes late without notice, the contact period is forfeited for that occasion.


PART V — COMMUNICATION

5.1 Parent-Child Contact During Custodial Parent's Time

The Custodial Parent shall facilitate reasonable telephone and/or video contact between the child(ren) and the Non-Custodial Parent:

  • Schedule: [________________________________] (e.g., Tuesdays and Thursdays at 7:00 PM)
  • Duration: Up to [____] minutes per call
  • Method: ☐ Phone ☐ Video (FaceTime/Zoom) ☐ Both

The Custodial Parent shall ensure the child(ren) have access to a phone during scheduled contact times.

5.2 Communication Between Parents

(a) Method: [________________________________] (e.g., OurFamilyWizard, email, text)
(b) Response time: Non-emergency messages within [____] hours.
(c) Emergency notification: The Custodial Parent shall notify the Non-Custodial Parent within 24 hours of any emergency, serious illness, injury, or hospitalization.

5.3 Non-Disparagement

Neither parent shall make negative, derogatory, or disparaging remarks about the other parent, that parent's family, or household members in the child(ren)'s presence or hearing.

5.4 Information Access

The Non-Custodial Parent shall have independent access to:

  • School records, report cards, and progress reports (directly from the school)
  • Medical, dental, and mental health records (directly from providers)
  • Notification of school events, parent-teacher conferences, and extracurricular activities

The Custodial Parent shall provide copies of report cards and significant medical information within [____] days of receipt.


PART VI — BEST-INTERESTS ANALYSIS UNDER 15 V.S.A. § 665(b)

The parties represent that this sole PR&R arrangement serves the child(ren)'s best interests under the nine statutory factors:

  1. Love, affection, and guidance — [________________________________]

  2. Material needs and safety — [________________________________]

  3. Developmental needs — [________________________________]

  4. Stability — [________________________________]

  5. Co-parenting / fostering other-parent relationship — [________________________________]

  6. Primary caregiver — [________________________________]

  7. Significant relationships — [________________________________]

  8. Communication and cooperation — [________________________________]

  9. Domestic violence / abuse — ☐ No evidence of abuse. ☐ Evidence addressed in Part VII.


PART VII — DOMESTIC VIOLENCE PROVISIONS

☐ Not applicable.

☐ Applicable — Under 15 V.S.A. § 665a, the court shall consider evidence that within the prior ten years, a parent has been convicted of domestic assault or has been found to have committed abuse as defined in 15 V.S.A. § 1101. The following conditions apply:

☐ All exchanges supervised or at a public location
☐ Parent-child contact supervised by [________________________________]
☐ Completion of a Vermont Council on Domestic Violence-approved intervention program
☐ Abstention from alcohol/controlled substances during and 24 hours before contact
☐ No overnight contact until [________________________________]
☐ Completion of parenting classes: [________________________________]
☐ Completion of substance abuse evaluation and treatment: [________________________________]
☐ Mental health evaluation and compliance with recommendations: [________________________________]
☐ Random drug/alcohol testing
☐ Relief from Abuse Order currently in effect: Docket No. [________________________________]
☐ Other: [________________________________]


PART VIII — RELOCATION

8.1 Custodial Parent Relocation

(a) The Custodial Parent may relocate with the child(ren) within Vermont with at least 60 days' written notice to the Non-Custodial Parent, including the new address, reason for move, and proposed modified contact schedule.

(b) Relocation outside Vermont requires either:

  • Written consent of the Non-Custodial Parent, filed with the court; or
  • Court approval after a hearing applying the 15 V.S.A. § 665(b) best-interest factors.

(c) The current contact schedule remains in effect until the court enters a new order.

8.2 Non-Custodial Parent Relocation

The Non-Custodial Parent shall provide at least 30 days' written notice of any change of address and shall propose modifications to the contact schedule if the move affects existing arrangements.


PART IX — DISPUTE RESOLUTION

9.1 Direct Communication

Parents shall first attempt to resolve disputes through direct communication within [____] days.

9.2 Mediation

If unsuccessful, parents shall participate in mediation before filing court motions.
☐ Vermont Family Mediation Program
☐ Private mediator: [________________________________]
Cost: [________________________________]

9.3 Guardian ad Litem

☐ The parties request appointment of a GAL under 15 V.S.A. § 669.
☐ A GAL is already appointed: [________________________________]
☐ Not applicable.

9.4 Court

Either parent may file a motion with the Vermont Superior Court, Family Division, [________________________________] Unit.


PART X — MODIFICATION

(a) This agreement may be modified by stipulation filed on Vermont Judiciary Form 400-00825 ($35 fee) or by court order.

(b) Contested modifications require a showing of real, substantial, and unanticipated change of circumstances under 15 V.S.A. § 668 ($120 fee).

(c) Under 15 V.S.A. § 668, whenever physical responsibility is modified, the court shall order a child support modification hearing.

(d) The Non-Custodial Parent may petition for expanded contact or shared PR&R upon demonstrating changed circumstances and that the modification serves the child(ren)'s best interests.


PART XI — CHILD SUPPORT

☐ The Non-Custodial Parent shall pay child support of $[________________________________] per month, calculated under the Vermont Child Support Guidelines (15 V.S.A. § 659).

☐ A separate child support order is being filed concurrently.

☐ Child support has been addressed in a prior order dated [__/__/____].

Health insurance: [________________________________] (parent) shall maintain health insurance.

Unreimbursed medical expenses: ☐ Split equally ☐ Proportional to income: [____]% / [____]% ☐ Other: [________________________________]


PART XII — ADDITIONAL PROVISIONS

12.1 Substance Use

Neither parent shall consume alcohol to impairment or use illegal substances during parenting time or within 12 hours preceding parenting time.

12.2 Firearms Safety

All firearms shall be stored unloaded in a locked container with ammunition stored separately, inaccessible to the child(ren).

12.3 Return of Child(ren)

The Non-Custodial Parent shall return the child(ren) to the designated exchange location at the scheduled time. Failure to return the child(ren) without prior arrangement constitutes a material breach and may result in enforcement proceedings under 15 V.S.A. § 668a.

12.4 Child's Preference

The parents acknowledge that as the child(ren) mature, the court may consider the child(ren)'s reasonable preference under 15 V.S.A. § 665(b) if the court deems the child of sufficient age.


PART XIII — GENERAL PROVISIONS

(a) Governing law. 15 V.S.A. Chapter 11, Subchapter 3A.
(b) Jurisdiction. Vermont Superior Court, Family Division, [________________________________] Unit, with continuing jurisdiction under the UCCJEA (15 V.S.A. Chapter 20, §§ 1061–1096).
(c) Severability. Unenforceable provisions do not affect the remainder.
(d) Integration. This is the complete agreement regarding PR&R.
(e) Counterparts. May be executed in counterparts.


SIGNATURES

Custodial Parent:

Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

Non-Custodial Parent:

Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

Attorney for Custodial Parent (if applicable):

Signature: [________________________________]
Printed Name: [________________________________]
Vermont Bar No.: [________________________________]

Attorney for Non-Custodial Parent (if applicable):

Signature: [________________________________]
Printed Name: [________________________________]
Vermont Bar No.: [________________________________]


ORDER OF THE COURT

The Court has reviewed this Stipulation and, finding that sole parental rights and responsibilities to the Custodial Parent with parent-child contact for the Non-Custodial Parent serves the best interests of the child(ren) under 15 V.S.A. § 665(b), hereby:

☐ APPROVES this Stipulation and enters it as a court order.

☐ APPROVES WITH MODIFICATIONS: [________________________________]

☐ ORDERS a hearing on [__/__/____] at [____].

☐ ORDERS a child support hearing pursuant to 15 V.S.A. § 659.

IT IS SO ORDERED.

Date: [__/__/____]

[________________________________]
Judge, Vermont Superior Court — Family Division
[________________________________] Unit


Sources and References

  • 15 V.S.A. § 664 — Definitions (legal responsibility, physical responsibility)
  • 15 V.S.A. § 665 — Rights and responsibilities order; best interests of the child (nine factors)
  • 15 V.S.A. § 665(a) — Sole or primary PR&R when parents cannot agree to share
  • 15 V.S.A. § 665a — Conditions of parent-child contact (domestic violence)
  • 15 V.S.A. § 668 — Modification of order
  • 15 V.S.A. § 668a — Enforcement of order
  • 15 V.S.A. § 659 — Child support guidelines
  • 15 V.S.A. § 669 — Guardian ad litem
  • 15 V.S.A. §§ 1101–1115 — Abuse Prevention Act
  • 15 V.S.A. Chapter 20, §§ 1061–1096 — UCCJEA
  • Vermont Judiciary Form 400-00825 — Agreement on Parental Rights and Responsibilities
  • Vermont Judiciary — Family Division: https://www.vermontjudiciary.org/family
  • Vermont COPE Program (UVM Extension): https://www.uvm.edu/extension/families

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About this template

Last updated
April 7, 2026
Jurisdiction
Vermont
Category
Family Law

Legal authority

  • 15 V.S.A. § 665 — Rights and responsibilities order; best interests of the child
  • 15 V.S.A. § 665(a) — Award primarily or solely to one parent when parents cannot agree to share
  • 15 V.S.A. § 665a — Conditions of parent-child contact (domestic violence)
  • 15 V.S.A. § 664 — Definitions (legal and physical responsibility)
  • 15 V.S.A. § 668 — Modification of order
  • 15 V.S.A. § 669 — Guardian ad litem
  • 15 V.S.A. §§ 1101–1115 — Abuse Prevention Act

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.

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