Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
School Activities Access Notice
Pursuant to section 3109.051(J) of the Revised Code:
Subject to section 3319.321(F), each parent is entitled to access to any student activity that is
related to the child(ren) and to which the residential parent is legally provided access, under
the same terms and conditions as the residential parent. Any school employee or official w ho
knowi ngly fails to comply with this school activities access order is in contempt of court.
Restrictions or limitations:
Restrictions or limitations to school activities access are as follows:
THIRD: HEALTH INSURANCE COVERAGE.
As required by law, the parties have completed a Child Support Worksheet, which is attached to
and incorporated in this Agreement.
Health Insurance Coverage Available to at Least One Parent
Private health insurance coverage is accessible and reasonable in cost through a group policy,
contract, or plan to: Father Mother Both parents. Father Mother B oth paren ts
shall provide private health insurance coverage for the benefit of the child(ren).
If both parents are ordered to provide private health insurance coverage for the benefit of the
child(ren), Father’s Mother’s health insurance plan shall be considered the primary health
insurance plan for the child(ren).
The parent required to provide private health insurance coverage shall provide proof of insurance
County Child Support Enforcement Agency (CSEA)
Both parents shall cooperate in the preparation of insurance forms to obtain reimbursement or
payment of expenses, as applicable. A copy of medi cal bills must be submitted to the party
holding the insurance and responsible for payment or the other parent within 30 days of receipt.
Should the health insurance coverage be cancelled for any reason, the parent ordered to
maintain insurance shall immediately notify the other parent and take immediate steps to obtain
replacement coverage. Unless the cancellation was intentional, the uncovered expenses shall be
paid as provided above. If the cancellation was intentionally c aus ed b y the parent or dered to
maintain insurance coverage, that parent shall be responsible for all medical expenses that
would have been covered had the insurance been in effect.