Child Custody and Visitation Agreement

________________________________________ ("Custodian") shall have custody of

________________________________________ ("Child"), and control and supervision of
_________ [his or her] upbringing, subject to the following:

1. ________________________________________ ("Non-Custodial Parent") shall have the right

to visit the Child once each week, on either of the following days, between the following hours,
respectively: (A) on ______________ [day of the week] between _________________ [starting hour]
and ______________ [ending hour] or ______________ [alternate starting hour] and ______________
[alternate ending hour]; or (B) on ______________ [day of the week] between _________________
[starting hour] and ______________ [ending hour] or ______________ [alternate starting hour] and
______________ [alternate ending hour].

It is agreed that the Non-Custodial Parent will notify the Custodian on or before
___________________________ [day of the week and time of day] whether the Non-Custodial Parent
intends to visit the Child and on which of the designated days and times. If the day or hour selected is
inconvenient, the Custodian will notify the Non-Custodial Parent no later than
___________________________ [day of the week and time of day], and the Non-Custodial Parent
shall be permitted to visit the Child the alternate day or during the alternate hours.

2. Nothing contained in this agreement shall be construed as an obligation or a duty on the part of
the Non-Custodial Parent to accept custody of the Child at the time or for the periods indicated. The
intention of the parties is that the Non-Custodial Parent's right of visitation shall be entirely optional to
Non-Custodial Parent, and should the Non-Custodial Parent so desire, Non-Custodial Parent may
waive the privilege of visitation on any occasion and for any reason, without waiving Non-Custodial
Parent's right to future visits.

3. _____ Not applicable, or _____ Due to the present immaturity of the Child, the Non-Custodial
Parent shall not at the present time be entitled to take the Child away from the Custodian's home for
any period of time. However, if at a later date, when the Child becomes older, the Child personally
expresses a wish or desire to accompany his/her Non-Custodial Parent and spend with that parent a
period of time other than the periods set forth in this agreement, the Custodian will consent to such
partial custody at that time and for such period.

4. The Custodian shall promptly notify the Non-Custodial Parent in the event of illness of the Child.
The word "illness" shall be deemed to mean any illness, other than any illness from which the Child is
now suffering, which shall confine the Child to bed for more than two days.

5. On all matters of importance relating to the Child's health and education, the Custodian shall
consult and confer with the Non-Custodial Parent, with a view to adopting and following a harmonious
policy.

6. Neither party shall do anything which may estrange the Child from the other.

________________________________________ Date: ______________

Signature of Non-Custodial Parent
________________________________________
Non-Custodial Parent's Printed or Typed Name

________________________________________ Date: ______________

Signature of Custodian

________________________________________
Custodian's Printed or Typed Name