Loading...
HomeMy WebLinkAbout02-1585JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF. Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. NO. Q a -? 5 d5J MARIE C. GAJEWSKI, CIVIL ACTION - LAW Defendant CUSTODY AND NOW, comes the Plaintiff, John J. Gajewski, by and through his attorneys, Wix, Wenger & Weidner, P.C., and files the within Complaint for Custody against the Defendant, Marie C. Gajewski, averring as follows: 1. 2. 3. 4 The Plaintiff, John J. Gajewski, is an adult individual who currently resides at 264 Conestoga Street, Windsor, Connecticut 06095-2203. The Defendant, Marie C. Gajewski, is an adult individual who Plaintiff believes currently resides at 99 Lee Ann Court, Enola, Cumberland County, Pennsylvania 17025. Plaintiff seeks shared legal custody and shared physical custody of the minor child, Matthew C. Gajewski, who was born on October 18, 2001 of Plaintiff and Defendant. The child was conceived while the parties were married but was born out of wedlock. The parties were married on November 20, 1999 and divorced on October 4, 2001. The children are presently in the custody of the mother, the Plaintiff, Marie C. Gajewski, who resides at the address stated above. 6. Since his birth, the child has resided with the following people at the following addresses: NAMES ADDRESS DATES Marie C. Gajewski 99 Lee Ann Court Enola PA 17025 Birth -Present 7. The mother of the child, Marie C. Gajewski, who Plaintiff believes currently resides at 99 Lee Ann Court, Enola, Pennsylvania 17025, is a single person. 8. The father of the child, John J. Gajewski, who currently resides at 264 Conestoga Street, Windsor, Connecticut 06095, is a single person. 9. The relationship of the Plaintiff to the child is that of father. Plaintiff currently resides by himself. 10. The relationship of the Defendant to the child is that of mother. The Defendant currently resides with herself and the child. Plaintiff does not know if anyone else resides with Defendant. 11. Plaintiff has not participated as a party or witness, or in another capacity, in other litigation concerning the custody of the child in this or another court. 12. The Plaintiff has no information of custody proceeding concerning the custody of the child pending in any court in this Commonwealth or elsewhere. 13. The Plaintiff does not know of a person not a party to the proceedings that has physical custody of the child or claims to have custody or visitation rights with respect to the child. 14. The best interest and permanent welfare of the children will be served by granting the relief requested because: a. The parties should have shared legal custody so as to have input into major decisions affecting the child. b. This Court should order shared physical custody as Defendant has refused to allow Plaintiff to see his child since Matthew was born. Plaintiff proposes that each party have Matthew for six months per year. Because of the distance between the parties, Plaintiff proposes that each party have Matthew for one month at a time, and that the parent receiving custody provide the transportation from the other parent's residence. C. Defendant refuses to provide Plaintiff with her telephone number or address and forces all conversations and communications to be between their respective attorneys, which is preventing Plaintiff from establishing a relationship with his son. 15. Each parent whose parental rights to the child has not been terminated and the person who presently has physical custody of the child has been named as a party to this action. There are no other persons who the Plaintiff knows to have any claim or right to custody or visitation of the child. WHEREFORE, Plaintiff, John J. Gajewski, respectfully requests this Honorable Court to grant him shared legal and shared physical custody of the parties' minor child, and to grant such further relief as this Court deems just and appropriate. Respectfully Submitted, WIX, GER & WEIDNER F:\drg\3020 - Gajewski, John\1 1486 - Domestic Relations\Documents\custody complaint.doo By: David R. Getz, Esquire I.D. #34838 508 North Second Street Post Office Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Plaintiff Date: April 1, 2002 JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF. Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. . NO. MARIE C. GAJEWSKI, : CIVIL ACTION -LAW Defendant :CUSTODY I, John J. Gajewski, Plaintiff in the foregoing Custody Complaint, have read the said Custody Complaint and hereby affirm and verify that it is true and correct to the best of my personal knowledge, information, and belief. I verify that all of the statements made in the foregoing are true and correct and that false statements made therein r„ay subject me to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. DATE: J hn J. Gaj ki ,l •' NANCY K. TOLLEFSON NOTARY PUBLIC MY COMMISSION EXPIRES 0002005 ?.. S e? C1 ?? r? c. a? -?: ?'??` _ ? - ??? ': ? . ?: rv . ? ;= --: , rt rv r?S i (a? i JOHN J. GAJEWSKI IN THE COURT OF COMMON PLEAS OF PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA V. • 02-1585 CIVIL ACTION LAW MARIE C. GAJEWSKI DEFENDANT IN CUSTODY AND NOW, Tuesday, April 09, 2002 , upon consideration of the attached Complaint, it is hereby directed that parties and their respective counsel appear before _ Melissa P. Greevy, Esq. , the conciliator, at 301 Market Street Lemoyne, PA 17043 on Monday, May 06, 2002 at 12:30 PM for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and all existing Protection from Abuse orders, Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled hearing. FOR THE COURT, By: /s/ r Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 fo-IN VNVAWNN?d AiNnoo cis v-i-i -t?ivmo 90 :q Hd I 1 ddv ZO JOHN J. GAJEWSKI, Plaintiff VS. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW IN CUSTODY ORDER OF COURT AND NOW, this 30 ' day of /h 4y , 2002, upon consideration of the attached Custody Conciliation Report, it is ordered and directed as follows: 1. The Mother, Marie C. Gajewski, and the Father, John J. Gajewski, shall have shared legal custody of Matthew G. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph, each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. The Father shall have partial physical custody of the Child in accordance with the following progressive schedule: A. Beginning June 1, 2002, the Father shall have custody of the Child on alternating Saturdays from 12:00 noon through 2:00 p.m., at a location to be selected by agreement of the parties. B. Beginning on August 3, 2002, the Father shall have custody of the Child on alternating weekends on Saturday from 12:00 noon through 4:00 p.m. and on Sunday from 10:00 a.m. until 1:30 p.m. C. The parties shall cooperate in further expanding the Father's periods of custody as appropriate in light of the Child's needs and adjustment to the custody schedule on an ongoing basis. `dlllVAWS!ti Ni d t Y? 3. This Order is entered pursuant to an agreement of the parties at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. BY THE COURT, J. cc: David R. Getz, Esquire - Counsel for Father Samuel L. Andes, Esquire - Counsel for Mother JOHN J. GAJEWSKI, Plaintiff vs. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW IN CUSTODY CUSTODY CONCILIATION SUMMARY REPORT IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE 1915.3-8, the undersigned Custody Conciliator submits the following report: 1. The pertinent information concerning the Child who is the subject of this litigation is as follows: NAME DATE OF BIRTH CURRENTLY IN CUSTODY OF Matthew G. Gajewski, October 18, 2001 Mother 2. A Conciliation Conference was held on May 16, 2002, with the following individuals in attendance: The Father, John J. Gajewski, with his counsel, David R. Getz, Esquire, and the Mother, Marie C. Gajewski, with her counsel, Samuel L. Andes, Esquire. 3. The parties agreed to entry of an Order in the form as attached. Date Dawn S. Sunday, Esquire Custody Conciliator JOHN J. GAJEWSKI, Plaintiff V. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF. CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-1585 CIVIL ACTION - LAW CUSTODY PETITION FOR MODIFICATION OF CUSTODY ORDER AND NOW, comes the Plaintiff, John J. Gajewski, by and through his attorneys, Wix, Wenger & Weidner, and files this Petition for Modification of Custody Order, and in support thereof avers as follows: 1. The Petitioner is John J. Gajewski (the "Fattier"), an adult individual who currently resides at 1 Field Lane, Lititz, Lancaster County, Pennsylvania, 17543. 2. The Respondent is Marie C. Gajewski (the "Mother"), an adult individual who currently resides at 99 Lee Ann Court, E:nola, Cumberland County, Pennsylvania, 17025. 3. The parties are the parents of the minor child Matthew C. Gajewski (born October 18, 2001 (the "Child"). 4. On May 30, 2002, as a result of a custody conciliation conference held by Dawn S. Sunday, Esquire, this Honorable Court entered an Order of Court relating to custody of the Child (the "Order"). A true and correct copy of the Order is attached hereto as Exhibit A and is incorporated herein by reference. 5. Paragraph 3(c) of the Order provides that "the parties shall cooperate in further expanding the Father's periods of custody as appropriate in light of the Child's needs and adjustment to the custody schedule on an on-going basis." (emphasis added). 6. At the time that this Court entered the Order, the Child was only 7 months old. 7. Since the date of the Order, Father has left his home in Connecticut and voluntarily relocated to Lititz, Lancaster County, in order to be closer to his son. Father now lives approximately 52 miles from Mother, which is about a one-hour drive. 8. Father has asked Mother on numerous occasions to allow him more time with the Child than the few hours set forth in the Order. Pursuant to the Order, Father has the Child for only 4 hours every other Saturday and 31/2 hours every other Sunday. Two hours of each visit is now spent in transporting the Child between the parents' homes. 9. Father has asked Mother for overnight visits, as he is spending much of his time now driving the Child back and forth to his home in Lititz. 10. Father began discussing increased periods of partial physical custody with Mother in June 2003 after he had moved to Lancaster County. Mother has rebuffed all efforts by Father to have additional time with the Child. 11. Attached as Exhibit "B" is Father's letter to Mother dated June 17, 2003. 12. Most recently, Father's counsel contacted Mother's new counsel and asked for additional time, which request was rejected by Mother. 13. Attached as Exhibit "C" is a letter from Mother's attorney to counsel to Father dated July 8, 2004, rejecting any increase in Father's time with the Child. 14. As Father has voluntarily relocated to Pennsylvania, it is in the best interest of the Child that Father should receive: additional periods of custody with the Child, including at least every other weekend from Friday afternoon until Sunday evening, alternating holidays, and several weeks in the summer. 15. The Order should be modified because: a. Father has relocated from Connecticut to Lancaster County, Pennsylvania in order to have more time with his Child; 2 b. The original order was entered when the Child was only 7 months old. As the Child is now nearly 3 years old, it is appropriate that the Child should have more time with his Father. c. The original Order of Court envisioned that Father would have expanded periods of custody, but Mother has resisted. d. Modification of the Order is in the best interest of the Child in order to provide for consistency and predictability of the custody arrangement for all parties involved and because the Child should spend substantial amounts of time wiith each parent. 16. Plaintiff requests that this case be referred to a custody conciliation with Dawn S. Sunday, Esquire, who is familiar with this case. 17. On information and belief, Plaintiff believes that Defendant may be considering moving from Cumberland County in the future and wants to establish his rights to additional custody before Mother attempts to relocate. WHEREFORE, Plaintiff respectfully requests that this Honorable Court modify the existing Order to grant Plaintiff additional time with the Child as set forth above. Respectfullly Submitted, WIX, WENGER & WEIDNER, P.C. By: 77-E, David R. Getz, I.D.#34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Plaintiff Date: F:\drg\3020 - Gajewski, J0hn\11488 - Domestic Relations\DocumentsTetition to Modify Custody Order.doc 3 EXHIBIT "A" NAY 2 9 200[ JOHN J. GAJEWSKI, Plaintiff vs. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW IN CUSTODY ORDER OF COURT AND NOW, this 30t?- day of I Z):1 2002, upon consideration of the attached Custody Conciliation Report, it is orddeured and directed as follows: 1. The Mother, Mane C. Gajewski, and the Father, John J. Gajewski, shall have shared legal custody of Matthew G. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph, each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. The Father shall have partial physical custody of the Child in accordance with the following progressive schedule: A. Beginning June 1, 2002, the Father shall have custody of the Child on alternating Saturdays from 12:00 noon through 2:00 p.m., at a location to be selected by agreement of the parties. B. Beginning on August 3, 2002, the Father shall have custody of the Child on alternating weekends on Saturday from 12:00 noon through 4:00 p.m. and on Sunday from 10:00 a.m. until 1:30 p.m. C. The parties shall cooperate in further expanding the Father's periods of custody as appropriate in light of the Child's needs and adjustment to the custody schedule on an ongoing basis. 3. This Order is entered pursuant to an agreement of the parties at a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the tenns of this Order shall control. BY THE COURT, Z'-51 Ck J. cc: David R. Getz, Esquire - Counsel for Father Samuel L. Andes, Esquire - Counsel for Mother TRUE COPY FROM RECORD In Testimony whereof, I here unto set my hand and the seal of said Court at Carlisle, Pa. This ....3/ ..... day Of. r ...., cc ? ............... :.... ((// ?'{ Protho . EXHIBIT "B" June 17, 2003 Ms. Marie Gajewski 99 Lee Ann Court Enola, PA 17025 Re: Matthew Gajewski Marie: John J. Gajewski 1851 Shady Oak Drive Mount Joy, PA 17552 1-717-653-8471 I am enclosing Matthew's cap which was left by mistake in the car during his most recent visitation. As you recently learned, I have relocated from New England a driving distance of 350 miles so that I can be closer to Matthew. The current Order of the Court dated May 30 2002 was written when Matthew was only 7 months old and when I was living in New England. Section 3 of that same Order of the Court indicates; "The Father shall have partial physical custody of the Child in accordance with the following progressive schedule:..." Part C of Section 3 reads "The parties shall cooperate further in expanding the Father's period of custody as appropriate in light of the Child's needs and adjustments to the custody schedule on an ongoing basis." Distance, travel expense and Matthew's age has made it difficult for me to expand the visitation schedule. Now that I am living nearby and Matthew is older, I wish to exercise the intent of Section 3. My visits with Matthew over the last year have gone very well. Matthew is a happy, well adjusted child and recognizes me as someone who loves and cares for him. Beginning on his next bi-weekly visit on June 28`h , I propose that we expand Matthew's visitation to include an overnight on Saturday evenings. I suggest that I pick up Matthew at 10:00 A.M. at a location of your choice and you pick him up at 4:00 PM on Sunday afternoon at my residence. I recommend that we try this overnight schedule for 3 visitations and if they go well we expand them to include Friday evenings. I feel that this is a reasonable expansion of the current visitation schedule and will allow Matthew an opportunity to develop a more closer relationship with his Father. I hope that you find this proposal reasonable and I would be willing to explore your thought how this goal can be attained. I would also like to remind you that Section 3 of the same Order of the Court indicates "The parties can modify the provisions of this Order by mutual consent." And I pray we can modify and expand Matthew's visitation schedule without involving the courts and adding undue legal expenses. However, if you not wish to work with me on this issue, I will have no choice but to try to adjudicate a fair decision from the court. If this is the direction you wish to proceed; please provide me the name, address and phone number of your new attorney. Please let me know what you decision in this matter as soon as possible. Sincerely, John J. Gajewski EXHIBIT "C" DIANE G. RADCLIFF, ESQUIRE Attorney at Law wva inmate Koad Phone: (717) 737-0100 Camp Hill, Pennsylvania 17011 Facsimile: (717) 975-0697 July 8, 2004 David R. Getz, Esquire 508 North Second Street Harrisburg, PA 17101 Re: Gajewski v. Gajewski Dear David: I received a message from Marie Gajewski regarding your proposed changes to the visitation schedule indicating that she will not agree to your schedule. Based on our prior conversation I assume you will be initiating an action to modify the existing order. If you decide to file such an action, you. may send the Petition to me. I anticipate that I will be retained within the week and will thus be in a position at that time to accept service thereof. Should you have any questions or comments pertaining to this letter, do not hesitate to contact me. truly yours, CLIFF, ESQUI DGR/dr cc: Marie Gajewski File TRANSMITTED BY MAIL I, John J. Gajewski, Plaintiff in the foregoing Petition, have read the foregoing Petition and hereby affirm and verify that it is true and correct to the best of my personal knowledge, information and belief. I verify that all of the statements made in the foregoing are true and correct and that false statements made therein may subject me to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. )Jo qna-jjewski, PI ntiff DATED J,- l ? 2004 JOHN J. GAJEWSKI, IN THE COURT OF COMMON PLEAS OF. Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 02-1585 MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant : CUSTODY CERTIFICATE OF SFRVI E I hereby certify that I served a true and correct copy of the foregoing Petition to Modify Custody Order in the above referenced matter via first class, U.S. mail postage prepaid on the following: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Respectfully submitted, WIX, WENGER & WEIDNER, P.C. By: ??. David R. Getz, I.D.#34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 2:34-4182 Attorney for Plaintiff DATE: f) 6) 7l?) li 1:- R ti IO (2R- i f lei N N co X? :s: iV t+.J 0 fT1 c iTA JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF. Plaintiff : CUMBERLAND (AUNTY, PENNSYLVANIA V. NO. 02-1585 MARIE C. GAJEWSKI, CIVIL ACTION - LAW CUSTODY Defendant I accept service of the Petition for Modification of Custody Order and for Contempt of Court in the above-captioned case. I hereby certify that I am authorized to accept service on behalf of Defendant, Marie C. Gajewski. Respectfully submitted, ff, Esquire ZDnj, 57011 448 Trindle'ad (717) 737-0100 DATE: Z©v`? h> ?> C7 llrfjl C' ?-T r c> s? ?_:: U7 (l I yrl JOHN J. GAJEWSKI IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. 02-1585 CIVIL ACTION LAW MARIE C. GAJEWSKI IN CUSTODY DEFENDANT ORDER OF COURT Thursday, August 05, 2004 upon consideration of the attached Complaint, AND NOW, _Dawn S Sunday Esq. the conciliator, it is hereby directed that parties and their respective counsel appear Tbefore hursday, September 02, 2004 at 8:30 AM at 39 West Main Street, Mechanicsbur , PA 17055 on for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot ilag five or older may also be present lat the Conference. lFailurecourt, to pp ear a t e conferen epmayy and to enter into a order. All children provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and all existing Protection from Abuse orders, Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled hearing. FOR THE COURT, mhc By; Da3zn S u ar Fs?- ------ Cusody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable is having business before the court, please contact our office. accommodations available to disabled individua All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR 11LEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE CumberlanCAN GET d County GBar AL HELP. on 32 South Bedford Street Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 e ??''? ? ems- 1// sEP Z " =e JOHN J. GAJEWSKI IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW VS. MARIE C. GAJEWSKI CUSTODY Defendant ORDER OF COURT z a` day of 2004, upon AND NOW, this liation Report, It is ordered and directed as follows: consideration of the attached custody Conci 1. The parties shall obtain a psychological assessment to be conducted by Arnold Shienvold, Ph.D. or other professional selected by agreement of the parties. The purpose of the assessment shall be to obtain guidance from an independent professional as to whether the partial custody schedule proposed by the Father is appropriate in light of concerns raised by the Mother in the custody situation. It is anticipated that the psychological assessment would include a session with the Mother to identify the concerns at issue prior to conducting psychological testing and further evaluation of the Father. The parties shall follow the recommendations of the counselor with regard to shall equally share all costs of the assessm and sign the assessment process. The authorization deemed necessary bysthe professional ondu ting the assessmentintorder to shallobtain any additional information. 2. Pending completion of the psychological assessment and further agreement of the parties or Order of Court, the prior Order of this Court dated May 30, 2002 shall continue in effect with the following modifications: of the Child on alternating weekends on A. The Father Saturday from shall 10:00 a.m. until 5:30 physical m. and on custody Sunday from 10.00 a.m. until 4:00 p.m. B. In 2004, the Mother shall have custody of the Child on Thanksgiving Day and, if the Mother is not traveling out of the area for the holiday, the Father shall have custody of the Child on the Friday after Thanksgiving from 10:00 a.m. until 5:30 p.m. 3. Within 60 days of receipt of written guidance from the psychological assessment, counsel for either party may contact the conciliator to schedule an additional custody conciliation conference. OF tp ?No)vo- l y 1894 SEP 26 P!I !: ! 3 uG?{`Jiv-, y . This Order to an agreement of the parties at a custody conciliation 4conference. The parti is es may entered modify pursuant the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. cc: avid R. jai'ane G Getz, Esquire - Counsel for Father Radcliff, Esquire - Counsel for Mother 4S o4-a9-oq BY THE COURT, JOHN J. GAJEWSKI Plaintiff VS. MARIE C. GAJEWSKI Defendant Prior Judge: Kevin A. Hess IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW IN CUSTODY CUSTODY CONCILIATION SUMMARY REPORT IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE 1915.3-8, the undersigned Custody Conciliator submits the following report: 1. The pertinent information concerning the Child who is the subject of this litigation is as follows: NAME DATE OF BIRTH CURRENTLY IN CUSTODY OF Mother Matthew C. Gajewski October 18, 2001 2. A conciliation conference was held on September 15, 2004, with the following individuals in attendance: The Father, John J. Gajewski, with his counsel, David R. Getz, Esquire, and the Mother, Marie C. Gajewski, with her counsel, Diane G. Radcliff, Esquire. 3. The parties agreed to entry of an Order in the form as attached. ate.,, ao a? V, Date Dawn S. Sunday, Esqui Custody Conciliator JOHN J. GAJEWSKI IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. 02-1585 CIVIL ACTION LAW MARIE C. GAJEWSKI IN CUSTODY DEFENDANT ORDER OF COURT AND NOW, Friday, April 15, 2005 upon consideration of the attached Complaint, it is hereby directed that parties and their respective counsel appear before Dawn S. Sunday, Esq. the conciliator, at 39 West Main Street, Mechanicsburg, PA 17055 on Wednesday, May 18, 2005 at 10:30 AM for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and all existing Protection from Abuse orders, Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled hearing. FOR THE COURT. By: _/s/ Dawn S. Sunday, Esq __ .r!' Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the schedulec conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 "Telephone (717) 249-3166 1i7jt? "! -• t r ?? !7 t 17 tfyyF/ v yyt?E?? ? v! ?jl?' 6/?7 f t r e? t ;a wry RECEIVED MAY 262005` JOHN J. GAJEWSKI IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. 02-1585 CIVIL ACTION LAW MARIE C. GAJEWSKI Defendant IN CUSTODY ORDER OF COURT AND NOW, this 2 }• day of ?r? & , 2005, upon consideration of the attached Custody Conciliation Report, it d ordered and directed as follows: 1. The Father, John J. Gajewski, and the Mother, Marie C. Gajewski, shall have shared legal custody of Matthew G. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. Until the Child's fourth birthday on October 18, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Saturday at 9:00 a.m. through Sunday at 5:00 p.m., beginning Saturday, May 21, 2005 and, during weeks following the Mother's weekend periods of custody, on Monday from 4:00 p.m. until 6:00 p.m. The Father shall contact the daycare provider if he plans to pick up the Child prior to 4:00 p.m. 4. Beginning on October 21, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Friday at 6:00 p.m. through Sunday at 4:00 p.m. and every Wednesday from 4:00 p.m. until 6:00 p.m. The Father shall notify the daycare provider in the event he intends to pick up the Child earlier than 4:00 p.m. 5. The parties shall share or alternate having custody of the Child on holidays as follows: A. Christmas: The Christmas holiday shall be divided into Segment A, which shall run from Christmas Eve at 6:00 p.m. through Christmas Day at 1:00 p.m., and Segment B, which shall run from Christmas Day at 1:00 p.m. through December 26 at 6:00 p.m. In odd numbered years, the Father shall have custody of the Child during Segment A and the Mother shall have custody during Segment B. In even numbered years, the Mother shall have custody of the Child during Segment A and the Father shall have custody during , Segment B. In 2005, the Father shall also have custody of the Child from December 28 at 6:00 p.m. through January 1" at 4:00 p.m. In future years, the parties shall equally share the remaining school holiday break after Segment B, with the specific dates and times to be arranged by agreement between the parties. B. Alternating Holidays: The parties shall alternate having custody of the Child from 9:00 a.m. until 6:00 p.m. on Easter, Memorial Day, Independence Day, Labor Day and Thanksgiving Day each year. In even numbered years, the Father shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Mother shall have custody of the Child on Memorial Day and Labor Day. In odd numbered years, the Mother shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Father shall have custody on Memorial Day and Labor Day. C. Mother's Day/Father's Day: In every year, the Mother shall have custody of the Child on Mother's Day and the Father shall have custody of the Child on Father's Day from 9:00 a.m. until 6:00 p.m. D. The holiday custody schedule shall supercede and take precedence over the regular custody schedule. 6. Each party shall be entitled to have a one-week period of uninterrupted custody with the Child in 2005, upon providing at least 30 days advance notice to the other party. Periods of custody under this provision shall be scheduled from Friday through Friday and shall include each party's regular weekend period of custody. The party providing notice first shall be entitled to preference on his or her selection of vacation dates under this provision. The parties shall attempt to be reasonable in accommodating special scheduling needs for travel/rental schedules. Each party shall be entitled to have custody of the Child for two non-consecutive uninterrupted weeks beginning in 2006 and either party may request a review regarding expansion of the vacation schedule in future years. 7. In the event either party intends to remove the Child from his or her residence for an overnight period or longer, that party shall notify the other party in advance and shall provide information concerning the address and telephone number where the Child can be contacted. 8. The non-custodial parent shall be entitled to have reasonable telephone contact with the Child with no interference or participation (listening in on the conversation) by the other parent or third parties. 9. The parties shall cooperate in exchanging information regarding the Child in a civil and cooperative manner. 10. Unless otherwise agreed between the parties, exchanges of custody under this Order shall take place at the Bob Evans restaurant at the Swatera Exit off I-283, with the exception of the weekday evening periods of custody, which shall take place at the River of God Church in Enola, Pennsylvania. 11. Neither party shall do or say anything which may estrange the Child from the other parent, injure the opinion of the Child as to the other parent, or hamper the free and natural development of the Child's love and respect for the other parent. Both parties shall ensure that third parties having contact with the Child comply with this provision. 12. This Order is entered pursuant to an agreement of the parties at a custody conciliation conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. BY THE COURT, cc: Vivid R. Getz, Esquire - Counsel for Father ?)Siane G. Radcliff, Esquire - Counsel for Mother V 5, ?) 0 } JOHN J. GAJEWSKI Plaintiff VS. MARIE C. GAJEWSKI Defendant Prior Judge: Kevin A. Hess IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 02-1585 CIVIL ACTION LAW IN CUSTODY CUSTODY CONCILIATION SUMMARY REPORT IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE 1915.3-8, the undersigned Custody Conciliator submits the following report: 1. The pertinent information concerning the Child who is the subject of this litigation is as follows: NAME DATE OF BIRTH CURRENTLY IN CUSTODY OF Matthew G. Gajewski October 18, 2001 Mother 2. A conciliation conference was held on May 18, 2005, with the following individuals in attendance: The Father, John J. Gajewski, with his counsel, David R.Getz, Esquire, and the Mother, Mane C. Gajewski, with her counsel, Diane G. Radcliff, Esquire. 3. The parties agreed to entry of an Order in the form as attached Date Dawn S. Sunday, Esquire Custody Conciliator JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v : NO. 02-1585 CIVIL TERM MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant :IN CUSTODY STIPULATION FOR ENTRY OF CUSTODY ORDER AND NOW, this &day of 9u 2005, Marie C. Gajewski, ("Mother") and John J. Gajewski, ("F ther") hereby stipulate and agree to the entry of the foregoing Custody Order regarding custody of their minor child, Matthew C. Gajewski, born October 18, 2001, (the "Child"). IN WITNESS WHEREOF the parents, intending to be legally bound hereby, have set their hands and seals the day and year below written. WITNESS: (SEAL) MARIE C. GAJEWS I Date: /G a s- (SEAL) J H J. EWSKI Date: <F( 0 % c^i o h` N -r_r CJ t U7 cj C'J C? ' rr? L\ RECE VEJ AUG 2"' M ?r JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v : NO. 02-1585 CIVIL TERM MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant : IN CUSTODY ORDER OF COURT AND NOW, this 24 r day of 1-7yp2005, upon consideration of the attached Stipulation, it is ordered and directed as follow 1. The Father, John J. Gajewski, and the Mother, Marie C. Gajewski, shall have shared legal custody of Matthew C. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decision affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. Until the Child's fourth birthday on October 18, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Saturday at 9:00 a.m. through Sunday at 5:00 p.m., beginning Saturday, May 21, 2005, and during weeks following the Mother's weekend periods of custody, on Monday from 4:00 p.m. until 6:00 p.m. The Father shall contact the daycare provider if he plans to pick up the Child prior to 4:00 p.m. 4. Beginning on October 21, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Friday at 6:30 p.m. through Sunday at 4:30 p.m. and every Wednesday from 4:00 p.m. until 6:00 p.m. The Father shall notify the daycare provider in the event he intends to pick up the Child earlier than 4:00 p.m. 5. The parties shall share or alternating having custody of the Child on holidays as follows: A. Christmas: The Christmas holiday shall be divided into Segment A, which shall run from Christmas Eve at 6:00 p.m. through Christmas Day at 1:00 p.m., and Segment B, which shall run from Christmas Day at 1:00 p.m. through December 26 at 6:00 p.m. In odd numbered years, the Father shall have custody of the Child during Segment A and the Mother shall have custody during Segment B. In even numbered years, the Mother shall have custody of the Child during Segment A and the Father shall have custody during Segment B. In 2005, the Father shall also have custody of the Child from December 28 at 6:00 p.m. through January 1 at 4:00 p.m. In future years, the parties shall equally share the remaining school holiday break after Segment B, with the specific dates and times to be arranged by agreement between the parties. B. Alternating Holidays: The parties shall alternate having custody of the Child from 9:00 a.m. until 6:00 p.m. on Easter, Memorial Day, Independence Day, Labor Day and Thanksgiving Day each year. In even numbered years, the Father shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Mother shall have custody of the Child on Memorial Day and Labor Day. In odd numbered years, the Mother shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Father shall have custody on Memorial Day and Labor Day. C. Mother's Day/Father's Day: In every year, the Mother shall have custody of the Child on Mother's Day and the Father shall have custody of the Child on Father's Day from 9:00 a.m. until 6:00 p.m. D. The holiday custody schedule shall supercede and take precedence over the regular custody schedule. 6. Each party shall be entitled to have a one-week period of uninterrupted custody with the Child in 2005, upon providing at least 30 days advance notice to the other party. Periods of custody under this provision shall be scheduled from Friday through Friday and shall include each party's regular weekend period of custody. The party providing notice first shall be entitled to preference on his or her selection of vacation dates under this provision. The parties shall attempt to be reasonable in accommodating special scheduling needs for travel/rental schedules. Each party shall be entitled to have custody of the Child for two non- consecutive uninterrupted weeks beginning in 2006 and either party may request a review regarding expansion of the vacation schedule in future years. 7. In the event either party intends to remove the child from his or her residence for an overnight period or longer, that party shall notify the other party in advance and shall provide information concerning the address and telephone number where the Child can be contacted. 8. The non-custodial parent shall be entitled to have reasonable telephone contact with the Child with no interference or participation (listening in on the conversation) by the other party or third parties. 9. The parties shall cooperate in exchanging information regarding the Child in a civil and cooperative manner. 10. Unless otherwise agreed between the parties, exchanges of custody under this Order shall take place at the Bob Evans restaurant at the Swatara Exit off 1-283, with the exception of the weekday evening periods of custody, which shall take place at the River of God Church in Enola, Pennsylvania. 11. Neither party shall do or say anything which may estrange the Child from the other parent, injure the opinion of the Child as to the other parent, or hamper the free and natural development of the Child's love and respect for the other parent. Both parties shall ensure that third parties having contact with the Child comply with this provision. 12. This Order is entered pursuant to an agreement of the parties. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. Distribution to: David R. Getz, Esquire, 508 N. Second Street, Harrisburg, PA 17101, counsel for Father Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011, counsel for Mother Q, 3o 0S' RV TI-IF rr11 IRT- zs -Ol W11, OC ON 908Z uN,lJ'-'d :Hl do ?w!1:Q-Q3il? Prepared by: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 ID# 32112 Phone 717-737-0100 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. GAJEWSKI, : NO. 02-1585 CIVIL TERM Plaintiff CIVIL ACTION - LAW v MARIE C. GAJEWSKI, Defendant IN CUSTODY PETITION FOR SPECIAL/EMERGENCY RELIEF TO THE HONORABLE, THE JUDGES OF SAID COURT: Petitioner, Marie C. Gajewski, by her Attorney, Diane G. Radcliff, Esquire, files the above referenced Petition and represents that: 1. Your Petitioner is Marie C. Gajewski (hereinafter referred to as "Mother") and is the Defendant in the above captioned custody action. 2. Your Respondent is John J. Gajewski (hereinafter referred to as "Father") and is the Plaintiff in the above captioned custody action. 3. The parties are the parents of a minor child, Matthew C. Gajewski, (hereinafter referred to as "Child") born October 18, 2001. 4. Custody of the Child is governed by an Order of Court dated August 29, 2005. A true and correct copy of the Order of Court is attached hereto, marked Exhibit "A" and made a part hereof ("8/29/05 Order"). 5. Pursuant to the 8/29/05 Order, the parties share legal custody of the Child. 6. Pursuant to the 8/29/05 Order Mother has primary physical custody and Father has partial physical custody of the Child. 7. In November Mother was informed that the Child would be evicted from the daycare school due to behavioral problems. The daycare school did, in fact, follow through and the Child was placed on leave from November 28, 2005 through the first week of January 2006. 8. Subsequent to the Child being placed on leave for behavioral problems, at Mother's insistence, but after consultation with Father, Mother arranged to have the Child evaluated by Dr. Cladel. As a result fo that evaluation Dr. Cladel diagnosed the Child as having ADHD as a result of which he prescribed Methylin, an ADHD medication, for the Child. 9. Both Mother and Father attended all meetings with Dr. Cladel and were present when the testing of the Child for ADHD was performed and the diagnosis and recommended treatment were discussed with Dr. Cladel 10. Father initially agreed that the Child could be prescribed a trial dose of ADHD medication. 11. After being placed on the ADHD medication, the Child's behavior greatly improved and Mother convinced the daycare school to have the Child to return to or remain in school based on him being on that ADHD medication. 10. While the Child's behavior in school greatly improved with the administration of the ADHD medication, Fatherwho had initially consented to the treatment and prescription of the ADHD medication, subsequently withdrew his consent for the medication when it came time to re-prescribed the same in February, 2006. 11. As a result of Father's refusal, and because the parties' had joint legal custody of the Child, Dr. Cladel was unwilling will not write a new prescription for the medication, it being his position that both parties must consent or there be an Order of Court directing the prescribing of the medication. 12. Since the Child has been removed from the ADHD medication his behavior deteriorated and the child was again threatened with expulsion from his daycare center/school. 2 13. When the Child's behavioral condition deteriorated and he was again threatened with school/day carte expulsion, Mother's Attorney advised Father's Attorney of this situation and prepared an initial draft of this petition which was provided to Father's Attorney on or about February 22, 2006. 14. Despite such advise and knowing that his son's condition had deteriorated and that he was having problems in school and was threatened with expulsion, Father continued to refuse to put the child back on the ADHD medication unless there was further testing and Mother agreed to go to co-parenting counseling with him, which had nothing to do with the Child's AND condition. A true and correct copy of Father's Attorney's letter dated 2/24/06 setting forth this position is attached hereto, marked Exhibit "B" and made a part hereof. 15. In the Father's Attorney's letter dated 2/24/06 attached as Exhibit "B" Father erroneous alleged that Dr. Cladel had not fully tested nor evaluated the Child and had given his diagnosis based solely on information supplied by Mother. 16. Mother was unable to file this Petition in February, 2006 as she felt she needed a written statement from Dr. Cladel of his diagnosis and prescribed treatment., even though Father was fully aware of the same. This statement was not obtainable until March 23, 2006 due to the fact that Dr. Cladel was out of town on a trip to Chile. 17. In the interim, the Child's condition further deteriorated as evidenced by the statement from the day care/school, attached hereto, marked Exhibit "C" and made a part hereof. 18. The Child's behavior became so bad and deteriorated since removing the ADHD medication to such an extent that he was asked to again requested to leave the school/day care effective March 17, 2006 following several violent outburst against other students. 19. On March 13, 2006, Dr. Cladel issued a letter to the parties reiterating his diagnosis of ADHD and his prescription of the medication, which was not received by Mother or her Attorney until March 17, 2006. A true and correct copy of Dr. Cladel's 3/13/06 letter is attached hereto, marked Exhibit "D" and made a part hereof. 20. Upon receipt of Dr. Cladel's letter, Father finally agreed to permit his son to take another trial dose of the AND medication for a second 30 day trial period and again 3 asked for additional testing. A true and correct copy of Father's and Father's Attorney's letters dated 3/16/06; 3/17/06 and 3/1906 `::evidencing this position is attached hereto, collectively marked Exhibit "E" and made a part hereof. 21. Between January 2006 when the medication was prescribed and March 23, 2006 when Dr. Cladel issued his letter attached as Exhibit "E", Father was in touch with the school on a weekly basis and knew of his son's deteriorating condition but nonetheless refused to consent to the prescription of ADHD medication for the child until March 16, 2006 after Dr. Cladel issued his March 23, 2006 letter. 22. Between January 2006 when the medication was prescribed and March 23, 2006 when Dr. Cladel issued his letter attached as Exhibit "E", Father had the ability to make inquiries of Dr. Cladel or any other physician he may have chosen to determine what testing had been done or should be done, but failed to take any such action. 23. No additional testing is necessary nor has Father made an specific allegations as to what testing should have been done, or should be done, to give verify the ADHD diagnosis . 24. As evidenced by Dr. Cladel's diagnosis and the Child's behavioral improvement after taking the ADHD medication and deterioration after being removed from the ADHD medication, the child should take the ADHD medication until the same is deemed no longer necessary by his treating physician, Dr. Cladel. 25. Mother fears that Father will again revoke his consent to the use of the ADHD medication after the end of this second 30 day trial period which will end around the thrid week of April, 2006.. 26. Whenever the child's behavior has deteriorated and he has been removed from School mother has been forced to take off work to care for the child. As the result she has used all of her sick and vacation days and is not taking time off without pay. 27. In December 2005, the Child was diagnosed as having an allergy to dog dander. 28. On December 12, 2005, Dr. Bertram Zumoff issued a report recommending that the child not be exposed to a dog. A true and correct copy of Dr. Zumoff's report is attached hereto, marked Exhibit "F" and made a part hereof. 4 29. Father has a dog in his house. Despite the issuance of Dr. Zumoff's report, Father refused to accept his recommendation and continued to expose the child to the dog. 30. The Child continues to have severe symptoms when exposed to the dog and is required to take prophylactic medication as a result of that exposure which would not be necessary if such exposure would not take place. 31. The parties are unable to agree under the legal custody provision on the aforesaid medication issue. An emergency situation exists due to the Child's allergic reaction to the dog and to the fact that the Child may be asked to leave the daycare/school if he is not placed on the required ADHD medication. 32. Mother has incurred attorneys fees and costs in bring this action in addition to to use of vacation pay, sick day and unpaid time off from work and claim is made therefor . WHEREFORE, Petitioner respectfully requests this Honorable Court to enter an order: * Directing that the Child continued to be prescribed and take such ADHD medication as may be prescribed by Dr. Cladel; ?t Directing that the Child not be exposed to Father's dog; ?r Requiring Father to pay Mother's reasonable attorneys fees and costs incurred regarding the matters governed by this Petition, including her lost wages for time off without pay, sick days and vacation days lost as a direct result of fathers refusal to consent to the use of the ADHD medication. Respectfully submitted, DIA RADCLIFF, ESQUIR the Road Camp Hill, PA 17011 Phone: (717) 737-0100 Supreme Court ID # 32112 Attorney for Petitioner 5 FEB-22-2006 13:37 DIANE RADCLIFF 717 975 0697 P.06i06 7 VERIFICATION Marie C. Gajewski verifies that the statements made in this Petition are true and correct. Marie C. Gajewski understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Marie C. Gajewski TOTAL P.06 CERTIFICATE OF SERVICE I, DIANE G. RADCLIFF, ESQUIRE, hereby certify that on March 29, 2006, 1 served a true and correct copy of the foregoing petition for Emergency Relief upon Respondent's Attorney by fax to David R. Getz, Esquire @ 717-234-4224 and by mailing same by first class mail, postage prepaid, addressed as follows: David R. Getz, Esquire 508 North Second Street Harrisburg, PA 17101 i JANE G. DCLIFF, ESQUIRE X448 T ' e Road Camp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 EXHIBIT "A" 8/29/05 COURT ORDER ?7CE: ED AUS ? ? C5 JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v : NO. 02-1585 CIVIL TERM MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant : IN CUSTODY ORDER OF COURT AND NOW, this 2 9 ? day of n + 2005, upon consideration of the attached Stipulation, it is ordered and irected as follows: 1. The Father, John J. Gajewski, and the Mother, Marie C. Gajewski, shall have shared legal custody of Matthew C. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decision affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. Until the Child's fourth birthday on October 18, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Saturday at 9:00 a. m. through Sunday at 5:00 p. m., beginning Saturday, May 21, 2005, and during weeks following the Mother's weekend periods of custody, on Monday from 4:00 p.m. until 6:00 p.m. The Father shall contact the daycare provider if he plans to pick up the Child prior to 4:00 p.m. 4. Beginning on October 21, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Friday at 6:30 p.m. through Sunday at 4:30 p.m. and every Wednesday from 4:00 p.m. until 6:00 p.m. The Father shall notify the daycare provider in the event he intends to pick up the Child earlier than 4:00 p.m. 5. The parties shall share or alternating having custody of the Child on holidays as follows: A. Christmas: The Christmas holiday shall be divided into Segment A, which shall run from Christmas Eve at 6:00 p.m. through Christmas Day at 1:00 p.m., and Segment B, which shall run from Christmas Day at 1:00 p.m. through December 26 at 6:00 p.m. In odd numbered years, the Father shall have custody of the Child during Segment A and the Mother shall have custody during Segment B. In even numbered years, the Mother shall have custody of the Child during Segment A and the Father shall have custody during Segment B. In 2005, the Father shall also have custody of the Child from December 28 at 6:00 p.m. through January 1 at 4:00 p.m. In future years, the parties shall equally share the remaining school holiday break after Segment B, with the specific dates and times to be arranged by agreement between the parties. B. Alternating Holidays: The parties shall alternate having custody of the Child from 9:00 a.m. until 6:00 p.m. on Easter, Memorial Day, Independence Day, Labor Day and Thanksgiving Day each year. In even numbered years, the Father shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Mother shall have custody of the Child on Memorial Day and Labor Day. In odd numbered years, the Mother shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Father shall have custody on Memorial Day and Labor Day. C. Mother's Day/Father's Day: In every year, the Mother shall have custody of the Child on Mother's Day and the Father shall have custody of the Child on Father's Day from 9:00 a.m. until 6:00 p.m. D. The holiday custody schedule shall supercede and take precedence over the regular custody schedule. 6. Each party shall be entitled to have a one-week period of uninterrupted custody with the Child in 2005, upon providing at least 30 days advance notice to the other party. Periods of custody under this provision shall be scheduled from Friday through Friday and shall include each party's regular weekend period of custody. The party providing notice first shall be entitled to preference on his or her selection of vacation dates under this provision. The parties shall attempt to be reasonable in accommodating special scheduling needs for travel/rental schedules. Each party shall be entitled to have custody of the Child for two non- consecutive uninterrupted weeks beginning in 2006 and either party may request a review regarding expansion of the vacation schedule in future years. 7. In the event either party intends to remove the child from his or her residence for an overnight period or longer, that party shall notify the other party in advance and shall provide information concerning the address and telephone number where the Child can be contacted. 8. The non-custodial parent shall be entitled to have reasonable telephone contact with the Child with no interference or participation (listening in on the conversation) by the other party or third parties. 9. The parties shall cooperate in exchanging information regarding the Child in a civil and cooperative manner. 10. Unless otherwise agreed between the parties, exchanges of custody under this Order shall take place at the Bob Evans restaurant at the Swatara Exit off 1-283, with the exception of the weekday evening periods of custody, which shall take place at the River of God Church in Enola, Pennsylvania. 11. Neither party shall do or say anything which may estrange the Child from the other parent, injure the opinion of the Child as to the other parent, or hamper the free and natural development of the Child's love and respect for the other parent. Both parties shall ensure that third parties having contact with the Child comply with this provision. 12. This Order is entered pursuant to an agreement of the parties. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. BY THE COURT: l rw x.? - 6?. co J. Distribution to: David R. Getz, Esquire, 508 N. Second Street, Harrisburg, PA 17101, counsel for Father Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011, counsel for Mother Ili rRUE COPY FROM RLCORU w ? y eot, f hers unto set my hares 8" N said Court at Carte Pa. Day d Prothonotaiv JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA 0 v : NO. 02-1585 CIVIL TERM MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant : IN CUSTODY r- ?- - L: a STIPULATION FOR ENTRY OF CUSTODY ORDER AND NOW, this ft"?day of flu 9 u ..t , 2005, Marie C. Gajewski, ("Mother") and John J. Gajewski, ("Father") hereby stipulate and agree to the entry of the foregoing Custody Order regarding custody of their minor child, Matthew e. Gajewski, born October 18, 2001, (the "Child"). IN WITNESS WHEREOF the parents, intending to be legally bound hereby, have set their hands and seals the day and year below written. WITNESS: ?h -4, rt. _ ?L j il/t'- c l?C --- (SEAL) MARIE C. GAJEWSKI Date: d14- to z n 4 ? c?? (SEAL) JOHJ?J J. JEWSKI Date: EXHIBIT "B" FATHER'S ATTORNEY'S 2/24/06 LETTER RICHARD H. WIX THOMAS L. WENGER DEAN A. WEIDNER STEVEN C. WILDS THERESA L. SHADE WIX' DAVID R. GETZ STEPHEN J. DZURANIN STEVEN M. WILLIAMS JEFFREY C. CLARK PETER G. HOW LAND STEPHEN P. SMITH KATHRYN L. WIX AI50 Mema2r MaSSaChuSCMS Bar Diane G. Radcliff, Esquire 3448 T riridle Road Camp Hill, PA 17011 RE: Matthew Gajewski Dear Diane: (717) 234-4182 FAX (717) 234-4224 www.wwwpalaw.com February 24, 2006 4705 DUKE STREET HARRISBURG, PA 17109-3099 Thank you for the draft Emergency Petition. I understand that Matthew is currently taking the medication prescribed by Dr. Cladel (or some other physician) when he is in Marie's custody, so I fail to see an emergency requiring the Court's intervention. Further, the averments in the Petition do not fairly state the facts. Mr. Gajewski is very concerned about the welfare of Matthew. He understands that Dr. Cladel diagnosed Matthew based on information provided by your client, and that he has not fully tested or evaluated Matthew. When the parties met with Dr. Cladel on January 24, 2006, the Doctor acknowledged that other variables in a child's life, such as stress and anxiety, can produce symptoms that can be confused with ADHD. It should be no surprise that Matthew is under stress as his parents have a great deal of difficulty communicating with one another. For example, Matthew has been exposed to your client's making negative comments about Mr. Gajewski in front of him, as I advised you by letter of November 9, 2006. My client understands that diagnosis often involves gathering information from multiple sources such as both parents and the day care provider. We do not know if this has been accomplished, nor do we have a copy of any report that Dr. Cladel may have written. If there is a report, please provide it to me. Further, my client understands that ADHD is very hard to diagnose in children younger than five years of age, and Matthew is only four. Mr. Gajewski does not observe the severe behavior problems asserted by your client when Matthew is in his custody. The first weekend he had Matthew after he began taking medication, he noted that Matthew was listless and wanted only to sit and watch TV. My client gave Matthew his medication that first weekend, but has not since that time. He has recently taken Matthew to Mass and noted that Matthew was able to sit through the service. To him, Matthew appears to be a typical active little boy. WIX, WENGER & WEIDNER A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HARRISBURG, PENNSYLVANIA 17108-0845 WIX, WENGER & WEIDNER Diane G. Radcliff, Esquire February 24, 2006 Page 2 For these reasons, my client simply asked Dr. Cladel to refrain from prescribing any further medication for Matthew until Matthew undergoes appropriate testing and the parties engage in parental counseling with Matthew. I believe that this type of counseling is what Dawn Sunday, Esquire, recommended some months ago. We believe that counseling would benefit Matthew and our respective clients, and we fail to understand why your client refuses to consider parental counseling. If your client insists in filing this petition, we will ask the Court to order that both parties and Matthew participate in parental and family counseling as part of its disposition of this matter. We believe that this will be In Matthew's best interest. As far as the issue of the dog, let me first reiterate that the dog belongs to my client's wife and daughters. My client has been aware of the dog danger allergy for some months, and he has acted accordingly. For example, he vacuums the house before Matthew visits, he has purchased HEPA air filters for the home, and he keeps the Matthew away from the dog as much as possible. Mr. Gajewski reports that Matthew is usually stuffy when he picks him up from his mother's care, and he does not believe that Matthew gets worse while at his home. The medication that Matthew is taking appears to be working. Additionally, my client lives in Lancaster County near farms. There are certainly many other allergens in the air. Frankly, I am curious why your client objects to having Matthew on allergy medication, but she is quite willing to have him on ADHD medication. Finally, we believe that there is no basis for attorneys' fees and costs in this matter. Our clients have a disagreement about appropriate medical treatment for their son. Your client walked out on the meeting that our clients had with Dr. Cladel where appropriate treatment options were being discussed. Surely the parties should communicate with one another instead of seeking court intervention every time there is a disagreement about Matthew's upbringing. Please let me hear from you after you discuss this matter with your client. Sincerely yours, WIX, LAGER & _ gy. avid R. Getz WEIIDDNE`RR - DRG/pak cc: Mr. John Gajewski EXHIBIT "C" SCHOOL/DAY CARE RECORDS hll=lR-15-2E1O6 0-:26 FROM:KCEASTFENN 17177281721 Knowledge Learning Corporations Wherc Ui etime l.caming Begins" March 15, 2006 Dear Maric: TO:9750697 F:2'2 1 am writing to update you on Matthew's status in the classroom. As you know, when Matthew fiat returned to KinderCare and was on medication, we had no incident reports and we were able to engage Matthew in classroom activities. He was able to establish meaningful relationships with his peers and his teachers. Over the last couple of weeks, l have noticed a dramatic decline in his behavior. Since stopping his medication, he has become aggressive, combative and unpredictable. 1 am very concerned for his well being as well as the safety of the other children in the classroom. As you know,l suspended Matthew for one day, 03/15/2006, because he had choked four children in the span of a few hours, causing one of them to vomit. When Matthew returns on 03/16/2006,1 will inform you immediately if there is another incident and Matthew will have to retrain out of school until his behavior is manageable. Our greatest concern is for Matthew's emotional well being. His peers have grown afraid of him and are avoiding play in situations where Matthew could pose a danger to them. Please, as always; keep me informed of any progress. 1 truly hope we can resolve this in a timely manner. Sincerely, s Mamie Johnson Center Director 730 0:'artniIle Road. Tie Fait °e ?.n Cenl? , Enola.'A 7025 Phorc 717.72c. 1720 Fox 717,72E.1?2' knpwleagclaoming corn 9P b, ?r1 Llyyv 3 ? -? X70 6l ?? not SCFQ ? t u 46, ?u a2rM L cy ?f` q _/1Z%iG be c °? E J C-Li l?-?c.?2,e L"-'r,-?f-t=(? ??1 .1-i?v?? ?'-L.i.C?L?iL 4 2??.;`Lc.?. _.L L?i..{..?G? Q-L.L. - ?.- Y Y -o: A C,-•!;C? ?^? ) n ?' r ? r ? l i L 1 r K r2C?Shed 6 lY?iv?( s ?r c-'?? 02/27/2006 Spoke with Mane about the increase in incident reports for Matthew. Expressed my concern for his safety as well as the safety of the other children in the class. Informed Marie that if this pattern continued, Matthew would be sent home. 03/01/2006 Jamie, Assistant Director, spoke with John Gajewski. Explained that Matthew had a rough day and that there were a number of incident reports to sign. She explained that if we didn't come up with a plan for his medication, we may need to consider other options for Matthew. 03/06/2006 Mane expressed concern to Jamie that one of the teacher's in Matthew's class had explained to Matthew's classmate that Matthew was having problems "because he didn't have his medicine". Spoke with both teachers about appropriate communication and defined expectations. 03/09/2006 Called Marie, left a message for her to return my call. Wanted to suggest sending Matthew home as he has hit 3 children this afternoon in a'/2 hour period. Mamie Johnson MEDICATION LOG ?J r 55 PA CODE CHAPTERS 3270.133; 3280.133; 3290.133 I GIVE PERMISSION TO ADMINISTER MEDICATION TO MY CHILD AS STATED BELOW , ({ 4 gys ry / r t l/ .. IdAINLTIF • s 1Jpf+?'I? NI Rvi'l R?f?l+alx` b?/ (lM(,?x4 x 'CHU: $N1410Fr i R?$! ?t ?"fiIUEQA i i . S3## f JRAVF?Y:: ®A7'? PPtR NY 6 WIKF Yf11`YE i iNEpI .1 T147N' I? f?l? DtYSAV iI f t l+l , •, ..,,. •,:, -TV 1h e7w A?__7ZW ' 1171-M No 1 I ll`i_ u) ?, •?'??.-I HI ?! !Y1/ ? I!'/) fry 5 rJJ co "j ?._ t?i? h 1; , 7r?t? t 5 7,?1s 5 ?„ dclkv 1 GG L t,C. ,?? ? w u ?G?c 04 (, r ? ? ?l? ? ttvf) p ? c AQ4, r 1i,.r) ? ti S ICt r7q o -t ?G - vt lL? ?t . e?? ING 7 ? t?l? ?'J , ? j' „ , ?, ?'?C•? j?P?4,.??„? P .-?? J? ive Pi??Y, J ? r,r jl{A?r. i (?,,1 /IA a,.. "P = PRESCRIPTION _ N = NON-PRESCRIPTION l G "?,r)F? MEDICATION LOG 55 FA CODE CHAPTERS 3270.133; 3260.133; 3290.133 1 GIVE PERMISSION TO ADMINISTER MEDICATION TO MY CHILD AS STATED BELOW fI 11 %1 /?G'.Gc 1& ` /V1:tlll/°fl?('u?Fl,c}.t 1?f 1? l2tv???t ?? u? wf) ? c ?' et, Car l IL1l / ., l tCA b C GGl i fG ECGI ESA ? I 1 ?h L/ 1 ?/ y1G ? 7 ri.'??! ??„ll,?')/'??/lr,(?P"'( ?'/I??7.?'!/?C?e?l.?'(/(L?(?? `7?! ? `Y 6 .?• ?1?n? P, `r3 4lr??•,! F l?+.Ua.f (. V i rr? `1?, / ?) / "•li U? 1 lJ "???` ?( ,V ?c?? DT P `J / >?cl?z ??stir ('??2 ?tc(li2rJ' AIM-" 5m nr id's 5 /1 <i ? rn 1 ?' j?.c? "P = PRESCRIPTION N = NON-PRESCRIPTION Y MEDICATION LOO 55 PA CODE CHAPTERS 3270.133; 3200.133; 3290.133 I GIVE PERMISSION TO ADMINISTE R MEDICATION TO MY C HILD AS STATED BE LOW r A1k9'?t hRR 1uT?6 SI?( NIIYU °" ' s xs Y "HU-L'!.'? btplM `' x 13AnA , fP` i ' sw <a iC1M '?i'ICS 1 ?M411?1tt 1 §`ew1 G 'llVll n ' Amoo. ?i a I , ' ,,, . . : . 'i a',s s lI?pICA'?141V, PIN l:fi1KEN: YJIR"fc?ilf: 'aE4?^ti 3AIV?'1%1. .13S???rf3(?' Ik .. ... ., ti vtti N ?R? -4l, Ala l atc 5m, ( >Zr 7 '7 ¢S m : S c v/1-7c pi / Np -:to 5 ?,-,? o 57)4 I. ?: , ± 8 ` ? ?/ l ?6 *` tq! "?f ! r t .? S ? ? £ 4T "F. 'vV ?CI] 5(n l f _x q a € : RL er . f . r no ? l O A br 'wJ 4 T ! e r 45 Go fJ ? r_ a. ? lk ed d rd ! r r I N s c? L q a tt +) ? a .' .. ? . J J? L n(f ft 4..r1. ?1 3 ne" °P = PRESCRIPTION N = `s MEDICATION LOG 55 PA CODE CHAPTERS 3270.133; 3200.133; 3290.133 1 GIVE PERMISSION TO ADMINISTER MEDICATION TO MY CHILD ((Ay? Shh STATED BELOW y'/ (I J??µy Q 4 t/ff % Jy?? IJ?W S // . ul /' ?IYAII?f'+ YI' /S 4 f hk'IYif+ ?j' ?'!' `Y0 1?` )??Hltl'I" }'sC?i i1??i hpfdi f11 b"IGN{#YR r " v / ?. .. p 11M 5m 1 •`91 = PRESCRIPTION N = NON-PRESCRIPTION .s INCIDENT/ACCIDENT REPORT FOR PARENT Kid's Choice" -A"e- w6m rir1,-__ eytly ('Pp -rf (1 `Ca144 /5 while- A4W?Aew Wds an'7y1a?di?di'a71xC ?/ KinderCcre TEACHER / Al rte . CJ1 e1C? Al e-) CENTER NUMBER DATE TIME AM M Above Date/Time should be when incident/accident occurred CHILD'S NAME I(/' \ C DATE OF BIRTH REP RTED BV X0 Q, PLACE OF OCCU NCE (I.E., FIELD TRIP, SSROOM, UTSIDE, ETC.) PAREN PHONE - Nature nciden Accident: PARENT NAME Action Taken: Q? J 14A t A AM PARENT ADDRESS J t SUPERVISOR NOTIFIED DATE f 2 ? Q TIME SAM lv M PARENT/EM ERGENCV CONTACT NOTIFIED ? By Telephone Person TIME 1 ?, ?, AM v PM Risk Manageme t -800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Po and, OR 97228-6760 SIGNATU PE?OF CENTER DIRECT ?? Y V"? t DATE 3 u7 I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by :aarent's/auardian's medical. dental or accident insurance. SIGNAT E F PATENT/ GUARDI N DATE ,?? ?' FPP-RIS-0230 6/04 INCIDEN ACCIDENT REPORT FOR PARENT WHITE -Parent YELLOW -Center File L Kid's Choice- .. KinderCare TEACHER CENTER NUMBER DATE TIME NV ss &+kl 1-711, 01/ 05 0 ? :avoPM I Above Date/Time should be when incident/accident occurred CHILD'S NAME ( vV DATE OF BIRTH REPORTEDRV (i/,JJ ? PLACE OF 0 CURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature of Inci rent Accident: ? -4be-'J i CICeA V PARENT NAME Action Taken: Ta^ ? 1YV\ CA?oc t)?? T'\1 OWL?L? PARENT ADDRESS -lP ? ? ,Lr1aS ?+ s ne SUPERVISOR NOTIFIED DATE O TIME El AM ? PM PARENT/ EMERGENCY CONTA T NOTIFIED ? By Telephone In Person TIME AM ? Risk Management 1-800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 SIGNATURE OF CENT ER DIRECTOR DATE I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by parent's /guardian's medical, dental or accident insurance. U E OF PARENT/G RDIAN _ p l (Jt?IF / DATE N' FPP-RIS-0230 6/04 r ? V WHITE - Parent YELLOW - Center File :?NCIDENT ACCIDENT REPORT FOR PARENT Kid's Choice' •• KinderCare' TEACHER N I'S I44, CENTER NUMBER DATE O ? ? .?J Q jl? TIME {5 AM ?•J/?PM Above Date/Time should be when incident /accident occurred CHILD'S NAME 1 ?y 1 I t:L. DATE OF BIRTH REPORTED BY PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC) PARENT PHONE ew Nature of ncidenAccident t+ l'l ` 4 -yr Ir e-YYl i rk PARENT NAME ne Q y'Q - ni) prnVO C(d I or) - Action Taken: f /\ 1 e` Y? t ?/ I r O irn l / ' V V 1 ?Vl ?I? ?? _t fF,?- -An rV-IIn PARENT ADDRESS A ? ' A ? A ? W c>_ S r e-yN% t r? e - n Vo-? ? LL e l SUPERVISOR NOTI IED DATE I q / 012) 0 Q ) TIME pl , M JL?J PAM PARENT/EMERGENCY ? By Telephone CONTACT NOTIFIED ? In Person TIME ? AM ? PM Risk Manag ent 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 SIGNATURE OF CENTER DIRECTOR DATE 7 w? I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by oarent's /auardian's medical. dental or accident insurance. SIG RE OF PARENT/GUARDIAN 11? Alt ? DATE a /?- G FPP-RIS-0230 6/04 INCIDENT/A CIDENT REPORT FOR PARENT WHITE - Parent YELLOW - Center File Kid's Choice- KinderCare' TEACHER F, 1? s a? l CENTER NUMBER DATE 17Z y ? 3 a TIME ?M w ?PM 2 Above Date/Time should be when incident /accident occurred ? CHILD'S NAME ( + ?? DATE OF BIRTH REPORTED B y A I Y I PLACE OF OCCURRENCE (LE., FIELD TRIP, CLASSROOM, OUTSIDE, ETC) PARENT PHONE sSrv C ? PARENT NAME e t ure o IncidentAccident: 0 eGl l r I t A a A- Sr1L1 C 41 yne i?)(i s ? Action Taken: u ? ! I' ` nu a C? PARENTADDRESS M w ? dk ?U t? l u ,e ?? I? ?. a MERGENCY T CONTACT NOTIFIED TIME SUPERVISOR IFIE DATE TIME ? AM PAPEN /E ? AM • ? PM ? BV Telephone ? In Person ? PM Risk Ma gement 1-800-352-4466 / Fax 1-503-872-1578 SIGNATUREO -CENTER DIRECTOR DATE P.O. Box 6760, Portland, OR 97228-6760 & a? I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by ATURE DE PARENT) GUARDIAN qhA DATE parent's I guardian's medical, dental or accident insurance. 1 IDENTYACCIDENT REPORT FOR PARENT Kid's Choice- - KinderCore TEACHER ?i (t?L CENTER NUMBER DATE TIME Above Date/Time should be when incident/accident occurred CHILD'S NAME i DATE OF BIRTH REPORTED BV ) PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature of cident ?Accident: /,(d?t?i.?y U1 c PARENT NAME tom' F?0_.lliYin-d?a? / U ?.?'if}t? (r-trP_a??-G3t- Action Taken: n ??? ' ?/? Wr r? Y iLTL"- PARENT ADDRESS 4 A' f { - `ft ?L-C.CiC It G] SUPERVISOR NOTIFIED DATE O TIME ?AM ? PM PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone ? In Person TIME DAM ? PM Risk Managemen 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 sc1N? UREO CENTER DIRECTOR DATE Ul';U U/ I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by narant'e l nuarrlian c madira) dental nr arrident incnranra sl URE OF PARENT(GUAR IAN DA FE ? Y -n' WVV 11 / / L" ' FPP-RiS-0230 6/04 WHITE - Parent YELLOW - Center File CiDE /ACCIDENT REPORT FOR PARENT Kid's Choice" ................... KinderCare TEACHER CENTER NUMBER /1 DATE 611 /1061 TIME / J;-Io -M Above Date/Time should be when incident/accident occurred CHILD'S NAME DATE OF BIRTH REPORTED BY PLACE OF OCCURRENCE ILE„ FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE V / Nature of ciden !Accident: a? e PARENT NAME !2- U Action Taken: rri ?4_ t e2e Y 71i mJ C1 /1 2 ?z.? C? PARENT ADDRESS SUPERVISOR NOTIFIED DATE U TIME SAM ? PM PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone rso TIME ?AM ? PM Risk Manage ent 1-800-352-4466 Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 sIGNATUREOF CENTER DIRECTOR 3- DATE 11 ` 1 understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by n nf'c /n,,nrd;nn'c mnr/inal dnntO[ nr arrlrlunt In C,,.n,. s c U PA NT/GUARDI N? DATE ?, U 1 l n A A? 3?} ?c, ?? ?° FPP-RIS-0233 6104 WHITE - Parent YELLOW - Center File INCIDENT CCIDENT REPORT FOR PARENT Kid's Choice° ........ .......... KinderCare TEACHER Yl? CENTER NUMBER l l DATE D 3 I ?f a TIME ?t5 °rM Above Date/Time should be when incident /accident occurred CHILD'S NAME DATE OF BIRTH REPORTED BY PLACE OF OCCURRENCE T.E.. FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE q n Nature of QCncilent Accident: m&tuw_IJ Clt cd /? ?c2iZ0?1I?Z ? PARENT NAME Action Taken (Lz A ??IZr? `?e c GJ ca Cc !Le_ 1 1- L PARENT ADDRESS SUPERVISOR NOTIFIED ` DATE - ( U TIME ?AM ? PM PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone ? In Person TIME ?AM ? PM Risk Mana ment 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 SIGNATURE OF CENTER DIRECTOR DATE ) U l understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by oarent's /guardian's medical. dental or accident insurance. SIGN TAE OF PARENT/GUARDI N TE /? __7t' !t ! ?J ?ji FPP-RIS-0230 6/04 1 CIDE /ACCIDENT J REPORT FOR PARENT WHITE - Parent I Kid's Choice- ................... YELLOW - Center File A- KinderCoureTEACHER -],y CENTER NUMBER DATE / TIME EIAM / ?1rF li? -51 ? I C'' 16 11 ??• 3o E-}PM Above Date/Time should be when incident /accident occurred CHILD'S NAME f? q?[/y DATE OF BIRTH REPORTED eV 1 PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature -of I cid /Accident: /I 't?aJ z ?ry PARENT NAME Action Taken: I 1 Lei Z? 7L J J C :l?}-Q7/C Y"\ PARENT ADDRESS SUPERVISOR NOTIFIED DATE (? 1 U v TIME ?AM 1:1 PM PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone ? In Person TIME ?AM ? PM Risk Managemen 1-800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 SIGNJTTUR^E OF CENTER DIRECTOR DATE (!?\ (p Q ?. 1 understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by parent's /.guardian's medical, dental or accident insurance. SI T RE OF PARENT/ GUARDIAN DAT 7ylvc? I'll ?ti ? . ??/" FPP-RIS-0230 6/04 WHITE - Parent YELLOW -Center File INCIDENT/*CCIDENT REPORT FOR PARENT Kid's Choice' ................... -1L KinderCare' TEACHER CENTER NUMBER DATE TIME []PM D.AM Above Date/Time should be when incident/accident occurred CHILD'S NAME ?Y DATE OF BIRTH flEPORTED HY PLACE OF OCCURRENCE 11{., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) 111 PARENT PHONE - Nature of Incident /Accident ' i ?r-r t`n 'r tL_'s PAREM NAME Action Taken: -- PARENT ADDRESS SUPERVISOR NOTIFlED DATE i TIME OAM FPM PARENT! EMERG ENCV CONTACT NOTIF IED 0 BY Telephone bid Person TIMH El AM iG <-'"t>:-_? PM Risk ManageYgent 1-800-352-4466/Fax 1-503-872-1578 P.O. Box 6760; Portland, OR 97228-6760 slcNAr Re of CENTER DIRECTOR it PATE , ?- t 9-- DO NOT FAX TO RISK MANAGEMENT UNLESS PROFESSIONAL MEDICAL ATTENTION ADMINISTERED SIGNATURE OF PANENTIGUARDIAN i7ATE z-_- FPP-RIS-0230 6/04 WHITE - Parent YELLOW - Center File INCIDENT/ACCIDENT REPORT FOR PARENT,. Kid's Cho ice- ..... TEACHER 1 / CENTER NUMBER DATE ` TIME E-,., AM 1 1:1 QPM ADOVe Late/ time snouia oe wnen Inclaent/accmem aceun ea CHILD'S NAME ra ; -', DATE OF BIRTH D BV REP??TE y g PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENTP ONE ` II• / ( Nature o( Inci7ent?'Accident: Y ?(? Y•' L[? ?' I V /'(t ^ ?' (?? `yf,`iCar' PARENT NAME Action Taken: - .) .: r' fib ?? _ l I rn^ a• PARENT ADDRESS y .i. SUPERVISOR NOTIFIED DATE TIME ? A PARENT/ EMERGENCY CONTACT NOTIFIED TIME El AM 0 _ Tel hone E7 n_'Ferson ? B El PM y , Risk Marfagement 1-800-352-4466 / Fax 1-503-872-1578 SIGNAL RE OF CENTER DIREC OR i D E P.O. Box 6760, Portland, OR 97228-6760 1 t - - , I_;> DO NOT FAX TO RISK MANAGEMENT UNLESS SIGNATURE OF PARENVGUARP.IAN ' DATE PROFESSIONAL MEDICAL ATTENTION ADMINISTERED. FPP-RIS-0230 6/04 WHITE - Parent YELLOW - Center File INCIDENT/ACCIDENT REPORT FOR PARENT Kid's Cho ice- ........ TEACHER CENTER NUMBER DATE TIME ?AM A Above Date/Time should be when incident /accident occurred / CHILD'S NAME .i DATE OF BIRTH REPORTED BV PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature of Incident /Accident: '? rlt PARENT NAME k t ?Q t_ce-j tl i Action Taken: /. + l' I ? ? ' PARENT ADDRESS I . ? • ? ? ?.t? Fi t r- 1 s>_. i'l.z- Lc-i? c ?„ 1 t - - ° - ti T -I N `? r 1 C4 V l ? ' 4,... _ , G L -di M• ry' ' t P SUPERVISOR NOTIFIED GATE 2 3 b TIME! ? AM : 7 PARENT/EMERGENCY CONTACT NOTIFIED ' TIME L ? AM M lj ?D n i ,Eon Person ? By Telephon PM e=a%' - )mt 1-800-352-4466 / Fax 1-503-872-1578 Risk ManagerI6e , D E OF CENTER DIRECTOR ;I SIGNATU , P.O. Box 6760; Portland, OR 97228-6760 mo 'I Pt,+ I DO NOT FAX TO RISK MANAGEMENT UNLESS SIGNATURE OF PARENT/ GUARDIAN i DATE PROFESSIONAL MEDICAL ATTENTION ADMINISTERED. FPP-RIS-0230 6/04 WHITE - Parent YELLOW - Center File INCIDENT/ACCIDENT REPORT FOR PARENT Kid's Choice- .............. ..... rc;.aorr., EACHER ry 'i, ?? CENTER NUMBER DATE TIME DAM 1 I ?> ?S irL-i r L E?"PM 61"161) A NAmk - BAT€ OF WITH R€PBRTED BY Cl 1 1 Y.'- ,v PLACE OF OCCURRENCE (LE., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature of Incident/Accident Z': PARENT NAME t, Action Taken: PARENT ADDRESS s ( r - SUPERVISOR NOTIFIED DATE TIME L ~£ 'LyH1Vl PARENT EMERGENCY CONTACT NOTIFIED TIME ?. DAM - '---% ?"' -?? ' ?'Vl ? By Tele one n Person t'11 ?Lffpm Risk Manage i 1-800-352-44661 Fax 1-503-872 1578 sIGNA REDFCeNT A - ERDIRECTry ;D T f P.O. Box 6760, Portland, OR 97228-6760 ! I1 ' 1 t DO NOT FAX TO RISK MANAGEMENT UNLESS SIGNATURE OF PARENT/GUARD ?N DATE PROFESSIONAL MEDICAL ATTENTION ADMINISTERED. I A 14 % - - I % r FPP-RIS-l 6104 r-?NCIDENT/ CCID'ENT REPORT FOR PARENT ' WHITE -Parent YELLOW -Center File Kid's Choice- ... .... --- - Kmilli are ItACt1ER A , ji? t y}° CENTER NUMBER DATE - TIME - AM I I 5 1 ` 11 r:'' gPM j Above Date/Time should be when incident/accident occurred CHILD'S NAME f 'i ` DATE OF BIRTH REPORTED BY ti.!/ r - c 1-: t --A w f, l -, / r PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE P,,,? I Nature of Incident /Accident: r -PAR ENT NAME I ' it 1 I ll - Y7 ^ Ii ?n / r nn r '} F Ct 4crI l Action Taken: it t-'.cA re k:A S I . r n i t , n n Z / i - PARENT ADDRESS , e? ,/V C' b E r-?- iaf A, is C SUPERVISOR NOTIFIED P ATE TIME ^ PARENT/EMERGENCY CONTACT NOTIFIED TIME AM " ?' I "`C ?' ? PM ? By Telephone tnl?i Person t`Y _ j;.+ t; ^i-{] PM Ri k M d 4 s an y'ement 1-800-352-4466 / Fax 1-503-872-1578 SIGNATURE OF CENTER DIRECTOR } ` DATE P.O. Box 6760, Portland, OR 97228-6760 , V !)?f 3z r DO NOT FAX TO RISK MANAGEMENT UNLESS SIGNATURE OF PARENTIGUARDIAN DATE, PROFESSIONAL MEDICAL ATTENTION ADMINISTERED. is r INCIDENT/ CCIDENT REPORT FOR PARENT Kid's Choice" -- KinderCare T CHER _ ?ss CENTER NUMBER 17 16 DATE 0i 'S I ( Q TIME ?A M a : P.PM Above Date/Time should be when incident /accident occurred CHILD'S NAME /• DATE OF BIRTH REPORTED B PLACE OF OCCURRENCE I E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) V I S S Ca+k PARENT PHONE ?p ? 11 Nature o Incide t/Accident: Ka'+kP\r.I k;? C1- IPc Y15 LIrN/?. -h PARENT NAME o r , Action Taken: ?? iti I ??t, A cl p PAR E NT ADDRESS SUPERVISOR NOTIFIED DATE c TIME c^?AM V M PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telepho e atO Person TIME ?AM PM Ri k s Manageme 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, P rtland, OR 97228-6760 SIGNATUR OF CENTER DIRECTOR DA n vV E n I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by parent's /guardian's medical, dental or accident insurance. sl N TOR F PARENT/cuARDIA DA E /? / W l Q ??? ` L FPP-RIS-0230 6/04 DENT ACCIDENT REPORT FOR PARENT WHITE - Parent YELLOW - Center File Kid's Choice- K nderCare TEACHER CENTER NUMBER DATE TIME M.-SS o o ¦? Above Date/Time should be when incident /accident occurred CHILD'S NAME DATE OF RIRTH REPORTED RV PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.) PARENT PHONE Nature of Incident /Accident: 1 S I t 1 PARENT NAME . & t re n _Q_,Yp A On1 ?I1P Action Taken: cA__ 1 P.Y?dS P ? -40 P r 0,6 PARENT ADDRESS C SUPERVI SOR NOTI FIEID ug '3 DATE TIME ?AM •Vl-J 3 M PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone Person TIME ?AM PM Risk Mana ment 1-800-352-4466/Fax 1- 03-872-1578 P.O. Box 6 0, Portland, OR 97228-6760 SIGNAT E OF CENTER DIRECTOR DAr c` E ?- I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by narant'c lnuardian'c madiral rlantal nr arc' SIG OF PARENTGUARD N A ( `9?ICIDENT/ CCIDENT REPORT FOR PARENT Kid's Cho ice- ... TEACHER _ CENTER NUMBER/ DATE /7 / TIME 2 RAM _3 OPM Above Datel ime should be when incident/accident occurred CHILD'S NAME uraie yr einin ??? L, PLACE OF OCCURRENCE (I.E., FIELD TRI CLASSROOM. UTSIDE, ETC.I PAREN ONE Nature of nciden /Accident: r C' PARENT NAME PARENT NAME Action Taken: 1 <e Yl 1 r t ( A ?L nV?. -y ? ? Y1 I C-e- ? ?l S PgRENT ADDRESS SUPERVISOR NOTIFIED DAT TIME ?AM FPM PARENT/EMERGENCY CONT TNOTIFIED ? By Telephone Person TIME ?AM ? PM Risk Management -800-352-44661 Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 SIGNATURE OF CENTER DIRECTOR D TE I understand that the Student Accident Program is a supplement to reimburse certain out-o(-pocket expenses that are not covered by IAN SIIGGNAATUR OF PARENTZ; /-},Ah DATE 7 lid, mu s/yual umuJ mewl. m, vm uo• o• ueemmn „iov. v.,e••. FPP-RIS-0230 6106 INCIDEI ACCIDENT REPORT FOR PARENT I WHITE - Parent YELLOW - Center File Kid's Choice- ................... - - KinderCare TEACHER 'N?i55 ?'lcC CENTER NUMBER `1 ILO 1 DATE 31 I- c? ?D TIME VM Above Date/Time should be when incident/accident occurred CHILD'S NAME DATE OF BIflTH REPORT BV C'R ?t PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM, OUTSIDE, ETC.I Lcu PARENT PHONE Nature o Incident Accident: ?TI ,I Lj,? ,1/t1,Fi? I?I 11X,0- PARENT NAIVE Action Taken: PARENT ADDRESS SUPERVISOR NOTIFIED dy)L1 (n L.-z DATE 0 TIME r ?AM D M PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone Person TIME ?AM ? PM Risk Management 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 sIGNnTUgE OF CENTER DIRECroRI DATE I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by nerenYs /m/arr ian's mndiral dantal nr acridant insurance. ?IGTTURE,Z)F 'PARENT/GU RDIA OA FPP-RIS-0230 6/04 f WHITE - Parent YELLOW - Center File NCIDENTACCIDENT REPORT FOR PARENT Kid's Choice" - KinderCarer TEACHER CENTER NUMBER GATE TIME / Above Date/Time should be when incident/accident occurred CHILD'S NAME /'y DATE OF BIRTH REPORTED BY PLACE OF OCCURRENCE (I.E., FIELD TRIP. CLASSROOM, OUTSIDE, ETC.) /I Ili'? SSI GOw1 PARENT PHONE ? / Nature of Incident /Accident: f? ? t"'a? j tf?ivJ ` / fC- PARENT NAME i > >fDr»/?ML? Yz? r> rf rr/ rrotok? ?o.? _ l Action Taken: ! }}II ?? ??IA ? ?E'I] U?! ?? ? l /•1'j Gt ?"? U-t ?? r?Q PARENT ADDRESS SUPERVISOR NOTIFIED DATE l? TIME ?AM ap-M PARENT/ EMERGENCY CONTACT NOTIFIED ? By Telephone ? In Person TIME ? 4 Risk Man gement 1-800-352-4466 / Fax 1-503-872-1578 P.O. Box 9760, Portland, OR 97228-6760 AT RE OF CENTER DIRECT SIGN ,,,,. D TE ? I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by parent's/quardian's medical. dental or accident insurance. Slc TuRE RENT/GUA? D?IIA /Vl d? qn ?, / J YXJ?J' " I?? DATE J /? y/j ? tj U {/ FPP-RIS-0230 6/04 INCIDENT CCIDENT REPORT FOR PARENT __Z=_- WHITE -Parent YELLOW - Center File Kid's Choice- ••••••••••••••••••• KinderCare' TEACHER 1 CENTER NUMBER DATE G TIME ?? LliT M Above Date/Time should be when incident /accident occurred CHILD'S NAME Ma+ DATE OF BIRTH REPOR D BV PLACE OF OCCURRENCE (I.E., FIELD TRIP. CLASSROOM, OUTSIDE, ETC.) PARENT PHONE p p Nature of Incident /Accident: V;r1 I 10 f V? ??lV y (b,??YY\LL? PARENT NAME Action Taken: ' L pl'YllY l ?/f ?_I 111 `Y /'1/'r? ?IT/ll?+l PARENT ADDRESS r ?l42-V SUPERVISOR NOTIFIED DATE v Q L ?4 TIME ?AM M PARENT/ EMERGENCY CONTACT NOTIFI ED ? By Telephone n Person TIME?? ?' ?AM ? PM Risk Manage` nt 1-800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 sICNATU oFCENTERDIRECroR DATE '/'? QS?' SL_. VA" .? ?.e.. Z I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by narent's l auardian's medical, dental or accident insurance. ATUR F PARENT1CU RDIAN DATE ! ^/ FPP-RIS-0230 6/04 WHITE - Parent YELLOW - Center File FNCIf)EN /ACCIDENT REPORT FOR PARENT 0 0Or PM Above Date/Time should be when incident/accident occurred C-1 cL ILE., Nature of Incident /Accident: .SC?Ca_ 7.h- (_1 YYIo ala la Risk Mahhgement 1-800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by parent's /guardian's medical, dental or accident insurance. FPP-RIS-0230 6/04 INCIDENT CCIDENT EPORT Kid's Choice- - ..... ..•..... .•. KinderCare PARENT PHONE 1.3a PARENT NAME EN Lo, rii 4RENT/EM6RGtNCY CON I AC I NO IIHED IIMt EDAM ? By Telephone 0 In Person ? PM SIGNATURE OF CENTER DIRECTOR DATE UBE OF PARENT) GUARDIAN DAT WHITE - Parent YELLOW - Center File FOR PARENT Kid's Choice" ..•.. ..... . KinderCare TEACHER CENTER NUMBER 171 DATE D / Jf? C?La TIME ?PM Above Date/Time should be whe n inudentlaccident occurred CHILD'S NAME -`?--`{- L 1 DATE OF BIRTH REPORTED BY PLACE OF OCCURRENCE II.E, FIELD TRIP, CLASSROOM, OUTSIDE, ETC.I PARENT PHONE Nature of Incident /Accident: r 2W u Wa r7? I tI CA 1- i • `h PARENT NAME S tion Taken: h t c h 1 ' a 1 I ? PARENT ADDRESS n ?r & A`y I V , J - (f . efi c .5 Ire SUPERVISOR NOTIFIED DATE 77 G ? TIME DAM LJ M PARENT)EMERGENCY CONTACT NOTIFIED ? BY Telephone In Person TIME ` EDAM PM Risk Manag ent 1-800-352-4466 / Fax 1-503-872-1578 PO. Box 6760, Portland, OR 97228-6760 l understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered I parent'slguardian's medical, dental or accident insurance. FPP-RIS-0230 6104 SIGNATU E OF CENTER DIRECT r . D TE C-M 2- 12- ts 2- tS 'C SlI ATllfl OF PARENT/GUARD AN DATE PIQCIDEN?/ACCIDENT REPORT FOR PARENT Kid's Choice" Kinderccre iewcnen Ji M?ss C CENTER NUMBER DATE TIME ?PM C,n c II Abavo 4ate/Time should be when incident/accident occurred CHILD'S NAME DATE OF BIRTH REPORTED BY e PLACE F OCCURRENCE (I.E., FIELD TRI , SSROOM, OUTSIDE, ETC.) 0L)-siCIe PARENT PHONE -I II- null Nature ofIncident /Accident: rC?CxSS ( Ofnltlc Ir1?ll lCv RENT NAME PA Gri Nhl?U. ) CCi _C so k Actio[Taken: UC Ll I C6L Lo C PARENT ADDRESS iY O I 1 CIS I SUPERVISOR NOTIFIED D/AT?E TIME C` r M PARENT/EMERGENCY CONTACT NOTIFIED TIME ? ^ M H I I' n e ' V 1 e3 ? t0 I ?w O PM ?@Y Tele hone ? in Person I I O M 1 Risk Managemewt 1-800-352-4466/Fax 1-503-872-1578 l N RE OF CENT R DIR P.O. Box 6760, Portland, OR 97228-6760 s E EC /DATE -- j Z 7 O I understand that the Student Accident Program is a supplement to SI URE OF PARENT/GUAR IAN DATE reimburse certain out-of-pocket expenses that are not covered by parent's /guardian's medical, dental or accident insurance. MZ-1 1d f/iL l ?7 FPP-RIS-0230 6/04 NCIDENTIACCIDENT REPORT FOR PARENT ? V WHITE - Parent YELLOW - Center File Kid's Choice' .....?..?........ KinderCare' TEACHER N C f ? LEN ? 7 I TIME ?_? CAM , I S ,I I L • PM 93 I Above Date/Time should be when incident/accident occurred CHILD'S NAME V?- DATE OF BIRTH REPORTED BV PLACE OF OCCURRENCE (I.E., FIELD TRIP, CLASSROOM. OUTSIDE, ETC.) ssr&? vrm PARENT PHONE Nature of Incident /Accident: ?l 1 j C1 I d PARENT NAME 1 n4 S I 6-o fa use- 1 W (.>_r +ec) "tD ?- - Action Taken: Cs? rri i nAeA Ma+i-ke_w b f 1 P Vy`-ls_5T 6' hi PARENT ADDRESS SUPERVISOR NOTIFIED S DATE a. C?J TIME 17 DAM M PARENT/ EMERGENCY CONTACT NOTIFIED ? BY Telephone Person TIME 11 AM OTA L&Pm Risk Management 800-352-4466 / Fax 1-503-872-1578 P.O. Box 6760, Portland, OR 97228-6760 SIGNATURIq OF CENTER DIRECT . !!>`- DATE 4-1 110 I understand that the Student Accident Program is a supplement to reimburse certain out-of-pocket expenses that are not covered by naranYc /nuarAian c madiral dental nr acrident insurance SIGNgURE F PARENT/ GUARDDt%N 7CvIX if(- tCL? ? ? DDAJE s "? ? FPP-RIS-0230 6/04 WHITE - Parent YELLOW - Center File EXHIBIT "D" DR. CLADEL'S LETTER &R-1i-2000 11:54AM FROW 'HU6PITAL The Spirit of Caring T-32T P,003/003 F-224 ,Match 13,, 2006 Ms. Marie Gajewski 99 Lee Ann Court Enola, PA 17025 Mr- John Gajewsl i I Field Lane Lititz, PA 17543 R):: Matthew Gajewski DOB: 10/18/01 To Whom It May Concern. I have been following Matthew Gajewski in my outpatient medication clinic at Holy Spirit Hospital for his diagnosed Attention Deficit Hyperactivity Disorder, (2ombined Type (DSM 111: 314.01), 1 have pmseribed Methylin medication for Matthew, which bas been effective in helping deal with this condition. Sincerely yours, Charles E. Cladel, it., KD Child/Adoleseeut Psyebtatnst. A Service of Holy Spirit Nealth System 503 Norch 21st Street • C,mnp Hill, PA 17011-2288 (717) 763.2100 EXHIBIT "E" FATHER'S 8t FATHER'S ATTORNEY'S 3 LETTERS March 16, 2006 Charles E. Cladel, Jr. M.D. Child/Adolescent Psychiatrist Behavioral Health Services 503 North 21" Street Camp Hill, PA 17011 Re: Matthew Gajewski Dear Dr. Cladel; John J. Gajewski I Field Lane Lititz, PA 17543 717-6253656 I am in receipt of your March 13, 2006 letter in which you diagnose my son Mathew Gajewski with Attention Deficit Hyperactivity Disorder. Please supply me any testing that you performed with my son in arriving at this diagnosis for my records. Please supply me with the specific test that were done, the outcome and the dates they were performed. Has this further testing ruled out all the other factors that might cause symptoms that mimic ADHD which we discussed during our last meeting? I was not aware that Marie arranged for you to do this further testing. Furthermore, I am confused why as to why Mathew is not on the Methylin if more testing did occurred. I learned yesterday he is having more difficulties in school. As my earlier letter to you indicated, 1 agreed to let Matthew continue this medication if Marie agreed to further testing. If testing did occur I was not informed of it. The continued lack of communication between Marie and me regarding Matthew still exists. This problem was outlined to you in my January 25, 2006 letter to you. Do you still agree that Matthew's situation could benefit from family counseling? Thank you! Sincerely, 4o n J. Gajewski cc: Marie Gajewski Dave Getz, Esq, MAR-1i-2006 11:54AM FROM- RICHARD H. WIX Th Q.MA5 L. WENGER OEANA. WEIDNER STEVEN C. WILDS THERESA L SHADE WIX' DAVID R. GETZ STEPHEN J. DZURANIN STEVEN M. WILLIAMS JEFFREYO. GLARK PETER G. HOWLAND STEPHEN P. SMITH I THRVN L WIX ;Im Mt..,"'GIcl ...It. V" Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 RE: Matthew Gajewski Dear Diane: March 17, 2006 T-321 P.0021003 F-224 4705 DUKe STREET HARRISBURG. PA 1YIOU-3099 My client is in receipt of a letter from Dr. Cladel dated March 13, 2006. 1 am enclosing a copy of that letter for your information. The letter states that Matthew should be medicated with Methylin and John agrees with that for a period of 30-days. During that 30-day period, John will be in contact with Dr. Cladel to determine exactly what tests that the doctor has performed, and to arrange for further testing and perhaps get a second opinion, if deemed necessary. Sincerely yours, WIX, WENGER & WEIDNER A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HARRISBURG. PENNSYLVANIA 17106-0645 (717) 2$4-4182 FAX (717) 234-4224 v .w PalaW.com WIX, WENGER & WEIDNER By. David R- Getz DRG/pak Enclosure cc: Mr. John Gajewski Sent by: WIX WENGER WEIDNER- 7172344224; 03/20/08 14:D4; jetFax g951;Page 3/3 March 19, 2006 Jobn Gajewski 1 Field Lane Lititz, PA 17543 1-717-625-3656 Charles B. Cadet, Jr., M.D. Holy Spirit Hospital 503 North 21" Street Camp Hill, PA 17011 Re: Matthew Gajewski DOB: 10/18/2001 Dear Dr. Cladel; 1 was informed that you would need a letter from me specifically informing you in writing that you now have my permission to supply my son, Matthew with a 30 day emergency prescription of the Methylio medication. Please accept this letter as my approval. I am hopeful that Ibis 30 day period will allow me the opportunity to review the lest results pcrformed and which I requested from you. It will also provide me an opportunity to consider if a second opinion, or if further testing may be warranted. Should you have a need to discuss these matters, I can be reached at 717-625-3656. Thank you for your ongoing cooperation and assistance in this maltet- Sincerely, jh11 Gajewski cc: Marie Gajewski Dave Getz, Esq. EXHIBIT "E" DR. ZUMOFF REPORT BERTRAM ZUMOFF, M.D. Allergy 3819 Carlisle Pike Camp Hill, PA 17011 Telephone: (717) 737-3472 December 12, 2005 James Daly, Jr., M.D. 2025 Technology Parkway Suite 108 Mechanicsburg, PA 17050 RE: Matthew Gajewski DOB 10/18101 Date seen: December 9, 2005 Dear Dr. Daly: Matthew is 4 year old referred for evaluation of cough, chest, congestion and wheezing. His parents were in the process of divorce in 2001 and his mother moved back to Central PA from Holyoke, MA. When Matthew was about 8 months old his father came to visit him here about every 3 weeks. The meetings took place in a hotel room. Matthew's lather moved back to this area about 2003 and Matthew began to visit him at his house where he was exposed to dog. Matthew had no symptoms just prior to visit but on returning home after visiting for 5-6 hours, his mother noted sneezing, cough, and "irregular breathing." Mother states that these symptoms were mild. In January 2005, alter an overnight visit, mother noted some "irregular breathing" but no wheezing. After another visit in January or February there was increased cough after the visit and Matthew was seen in you office where it was suggested that prophylactic Claritin be used before and during visits to father. Matthew continued to visit his father every other weekend this past summer. In August he returned home from weekend visit and had coughing throughout the night. Apparently cough also occurred in his father's house. Delsym provided no relief. He had a one week visit with his father 8/9-8/16 and mother thought Matthew was short of breath when she spoke with him on the phone. Father said Matthew was "fine." In late September Matthew had shortness of breath and wheezing after a weekend visit and he was seen in your office September 26. Wheezing was heard on physical examination and nebulized Xopenex was prescribed for home use. There was follow-up visit on September 29. RAST tests to dog and dust mite were ordered and both were positive. Since Matthew had no chest symptoms prior to weekend visits, it was thought that his exposure to dog was the trigger of his episodic cough and wheezing, These symptoms cleared after returning home from weekend visit. Except for the dog, he was not exposed to other animals or tobacco smoke at his father's house. In mid-November it was suggested that Singulair be administered starting 2 days before his visit. This medication seems to have been partially effective in preventing chest symptoms. Environmental History: Ile lives in a town house with electric hot air heating system and central a/c. Bedroom contains regular mattress, w/w carpet, and synthetic pillows. There are a few stuffed animals in the room but not on the bed. Living area is carpeted. There are no pets. Mother does not smoke. Past History: He has otherwise been well. Family History: Mother wheezes after exposure to animals. Physical Examination: Ht. 42'/? in. with shoes Wt. 39 lbs. P. 96/min R. 22/min EYES: Conjunctivae normal. EARS: TMs not visualized because of cerumen. NOSE: Turbinates mildly boggy and phtk. No increased secretion. No septal deviation. PHARYNX: Normal. NECK: No adenopathy. LUNGS: Clear, no wheeze or rates. HEART: RSR, no murmurs. SKIN: No rash. Enclosed is copy of skin testing that revealed positive tests to grass and ragweed which could account for occasional sneezing at mother's house. RAST tests of October 4, 2005 revealed positive tests to dust mites and dog. On multiple occasions history reveals that he is asymptomatic just before visiting his father's home and returns home with symptoms which have included cough and wheezing. This wheezing was heard on one occasion in your office. The histiuy and positive BAST test to dog suggests dog allergy. If dust mite were the trigger, I would suspect that he have more symptoms in his own house. Matthew Gajewski December 12, 2005 Impression: • Occasional sneezing this past summer could have been due to pollen or dust mite allergy. • I believe his history of increased weekend symptoms when visiting with his father are due to dog allergy; this is confirmed by Class 3 positive BAST test to dog. Recommendations: • The ideal solution is for Matthew not to be exposed to dog. If this occurred, he would not need prophylactic medications. • Second best, which may or not be effective, is not to allow the dog to be in Matthew's bedroom and to keep it confined to limited area of house when Matthew is visiting. Air filtration units are of dubious value. Rooms where Matthew spends his time, should be thoroughly vacuumed before visit. The effectiveness of these measures depend on how sensitive Matthew is to the dog. Some pet sensitive people have severe symptoms with only small amounts of exposure to dander and others who are less sensitive may tolerate limited exposure to dander. • Singulair 4 mg daily should be continued as you prescribed. If this fails to control symptoms, then prophylactic inhaled steroid, budesomde or fluticasone should be considered. If wheezing and shortness of breath occur despite these measures, he should be taken out of the house because continued exposure could cause severe attack of asthma necessitating emergency room visit. Thank you for referring Matthew. Sincerely yours, Bert" rani Z off, M.C. BZ(r r Enclds e C: Two copies to Mrs. Gajewski Allergy Tests Name (rf?S?I (?1 f} L Date Z 6 9 U5 z,y Prick Skin Tests Saline control Histarrne control ---> S lkrass J' L ragweed -plantain d alternana Lhormodcndroa c? pen cillium 0 aspergillus mix -cockroach _-D. fannae mite _D. pteronyssinus -cat -dog -horse feathers rabbit birch `oak -maple -poplar -sycamore -hickory _elm -ash -milk -egg -wheat __peanut sov -chicken beef -orange tomato /l,lt,? Intradermal Skin Tests Saline control- Histamine control- D. farinae mite (i00 U) -eat -parakeet ,dog hamster D pteronyssinus(1001) -horse -gerbil feathers _--gurnea pig -Timothy grass (1000) `ragweed (100) birch -Mixed grasses -ragweed (1000) ,oak ,Bermuda grass ,maple __poplar Molds _alternaria _hormodendron _?enicillium _aspergillus mix _helminthosporium _mucor _stemphyllium _pullularia -CPI cmcum _aspergillus fumigatus firsarium Bertram Zumoff, M.D. 3819 Carlisle Pike Camp Hill, PA 17011 (717)737.3472 -sycamore _hickorv -elm rec mix -milk -egg f? u S , `?,?t/rv J'.,6 /-,l RSST "Lj TU C? ? Cri?E-,mot" ?r.r ra? is j NICholG 1:IS L iLIUe, Chantilly SPei II-FB: IEFCRIVSIDN S PEC I.M E 1,: 56644743 REQU.SITION 000?0160 LAE, REF NO: ? COLLECTED= 10/01/2005 RECE7VD: 10/04/2005 RE, POR_H,D: 10/05/2005 Pest Name HOUSE DUST PANEL [NFCIEIMTIO:d PATIENT GAJEWSKI,MATTI1EW DOB: 10/18/2001. Age: 3Y GENDER: M SS: 800-43-B9B5 ID: M34732/M34734 09:33 00:01 10:55 In Range Out of Range ---------------------------------------------------------------------- ! I CONY! % Of, MOD ! ! !Allergen Name ! kU/L !CLASS! Ref.!CLASS! MOTE11 ! ---------------------------------------------------------------------- !House dust Greer (hi) . . . . . . .1 0.451 11 1221 A 2! ! \ !Douse dust iiollister-Stier (h2) .! 1.431 II! 262! A 31 ----------------------------------------------------- ------- __.._. -.- -- IMMUNOGLOBULIN E ANTIBODIES 57 kU/L <--160 ANi1dAL, PANEL k 3 . ! CORN! % of! MOD ! ! !ALlergen Name ! kU/L !CLASS! Ref.!CLASS! NOTE)f ! ------- .-_-..-------------------------------------------------------- __ !Cat dander (el) . . . . . . - .! <0.35! 0! 43! JI ! !Horse dander (e3) . . . . . . . . .! <0.35! D! 55! 01 !Dog dander (e5) . - • . . ? . .! 4-611 111! 7211 A 41 7 ------------------------ I-_-_-_-_---_-----_------_-__--___-_--_-_-..--- Immunocap allergen results may be expressed in either kU/L or as a percentage response of the patient specimen compared to the 0.35 kU/L calibrator(ASM: Alternate Scoring Method-Modified allergens). SPECIFIC LEVEL OF ALLERGEN lop SPECIFIC IgE CLASS kU/L % RESPONSE ANTIBODY 0 <0.35 < OR = 70 ABSENT/UNDETECTABLE 1 0.35 - D.70 71 - 110 LOW LEVEL 2 0.71 - 3.50 111 - 220 MODERATE LEVEL 3 3.51 - 17.5 221 - 600 HIGH LEVEL 4 17.6 - 50 601 -2000 VERY HIGH LEVEL S 51 -100 2001 -6000 VERY HIGH LEVEL 6 >100 >6000 VERY HIGH LEVEL See notes for designation of allergen tests using one or more analyte specific reagents. In those cases, the test was developed and its performance characteristics determined by Quest Diaanostics. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance is not necessary.0 GAJEWSr,T,MAr;FFhl - 56644743 I REPORT iTA us Final ORDERING PHYSICIAN DALY,JAMES F JR CLIENT INFORMATION 6781 PINNACLE HEALTH HARRISBURG HOS JAMES PIPER, ML-LAB DTRCC'1'OR 111 S- FRONT' STREET HARRISBURG. PA 17101 Reference Range Lab AMD AMD 11 X11 (1%???rDS Lfil Dlit, 1 `, C L?r0s??B5 `v VO/ Page 1 - Ccntinued on Page 2 3 G C G IF- T.J -1 _n RECEIVED MAR 3 U 2006 >a3Y:_. r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. GAJEWSKI, NO. 02-1585 CIVIL TERM Plaintiff V CIVIL ACTION - LAW IN CUSTODY MARIE C. GAJEWSKI, Defendant RULE TO SHOW CAUSE RE: MARIE C. GAJEWSKI'S PETITION FOR SPECIAL/EMERGENCY RELIEF AND NOW, this 3y? day of <L,t -f L , 2006, upon consideration of the within Petition, IT IS HEREBY ORDERED that a Rule is issued upon Respondent, John J. Gajewski, to show cause why this Court should not grant the Petitioner the relief requested in the within Petition. Rule Returnable at a hearing scheduled for the Z day of 2006 at 36 o'clock -.m. in Courtroom No. of the Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania. BY THE COURT: Judge 4 Distribution of this Order to: / * ney for Petitioner: Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011 torney for Respondent: David R. Getz, Esquire, 508 North Second Street, Harrisburg, PA 17101 (? \? Vs tel. P, ? .y 1:. U., L 7-4 RECEIVED MAR 3 0 2006 F3Y: 11 4 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. GAJEWSKI, NO. 02-1585 CIVIL TERM Plaintiff v CIVIL ACTION - LAW IN CUSTODY MARIE C. GAJEWSKI, Defendant RULE TO SHOW CAUSE RE: MARIE C. GAJEWSKI'S PETITION FOR SPECIAL/EMERGENCY RELIEF AND NOW, this 30 I'll day of 7 ll/LtJ 2006, upon consideration of the within Petition, IT IS HEREBY ORDERED that a Rule is issued upon Respondent, John J. Gajewski, to show cause why this Court should not grant the Petitioner the relief requested in the within Petition. Rule Returnable at a hearing scheduled for the Z day of 2006 at 3Q o'clock -(L-.m. in Courtroom No. of the Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania. BY THE COURT:: J Judge Distribution of this Order to: * ney for Petitioner: Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011 torney for Respondent: David R. Getz, Esquire, 508 North Second Street, Harrisburg, PA 17101 l 03 3?D -.- ?_ ?? . .. ??-. ,,,., •.; f., i V' r?V? ^- C V _ c ?i ?? Prepared by: David R. Getz, I.D.#34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Respondent JOHN J. GAJEWSKI, Plaintiff V. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF. CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-1585 CIVIL ACTION - LAW CUSTODY ANSWER TO PETITION FOR SPECIAL/EMERGENCY RELIEF AND NOW, comes the Respondent, John J. Gajewski, by and through his attorneys, Wix, Wenger & Weidner, and files this Answer to the Petition for Special/Emergency Relief of Marie C. Gajewski, as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. It is admitted that these events occurred. However, Mother did not timely inform Father of these behavioral problems until after the fact. 8. Admitted in Part and Denied in Part. It is admitted that parties attended an appointment with Dr. Cladel on December 20, 2005, and that Dr. Cladel subsequently diagnosed the Child as having ADHD. It is denied that the parties left the initial consultation with Dr. Cladel with a prescription for Methylin, as Mother and Father were both hesitant about putting the Child on the medication. Father understood that the parties would think about it and set up a follow-up appointment with Dr. Cladel to discuss this issue. 9. Admitted in Part and Denied in Part. It is admitted that Father and Mother were both in the physician's building at the same time. It is denied that both parents attended all the meetings and testings. Quite to the contrary, at the initial appointment on December 20, 2005, Mother insisted on meeting with Dr. Cladel alone for a period of nearly 90 minutes, while Father and Child were in the waiting room. Father has no idea what was said during that meeting. Father then met with Dr. Cladel, individually, with Mother and the Child in the waiting room, and she did not hear what Father told the doctor. Father is not aware of any testing of the Child. After the first appointment with the doctor on December 20, the parties had a second appointment on January 20, 2006. At this time, Mother and Father were in the same room with the doctor and by this time, Mother had obtained a prescription for Methylin. During this meeting with the doctor, Father requested that the parents agree to family counseling and further testing for the Child. At that point, Mother walked out of the physician's office. It is admitted that recommended treatments were discussed with Dr. Cladel. 10. Admitted, as Father believed that Mother and the doctor would continue to communicate with Father regarding the Child's treatment and prognosis. This has not occurred. By way of further answer, Mother has stated in front of Dr. Cladel that she did not need Father's permission to keep the Child on this medication and stated that she would find a doctor who would provide a prescription. 11. Admitted in Part and Denied in Part. It is admitted that the Child returned to the daycare school. After reasonable investigation, Father is without sufficient knowledge to know whether the Child's behavior "greatly improved". By way of further answer, while the Child was taking Methylin, there were at least three incidents (January 3, 2006; January 5, 2006 and February 23, 2006) where the daycare provider wrote an Incident Report about the Child. 10 (second). Admitted in Part and Denied in Part. It is admitted that Father withdrew his consent for the medication because Father felt that there was inadequate communication and testing of the Child. It is denied that the Child's behavior in school greatly improved, as set forth above. 11 (second). Denied. After reasonable investigation, Father is without information sufficient to form a belief concerning the averments of this paragraph, as Dr. Cladel has not communicated with Father and the same is therefore denied. 12. Admitted in Part and Denied in Part. On information and belief provided by Mother, this Child has been threatened with expulsion from the daycare center. However, it is denied that the Child's behavior had deteriorated. To the contrary, on March 29, when Father picked up Child from school, Father was told that the Child had initiated aggressive behavior toward another Child on that day, when he was taking the Methylin. 13. Admitted that Father's attorney was provided with a draft petition. 14. Denied. It is denied that further testing is not appropriate. It is also denied that counseling has nothing to do with the Child's condition. To the contrary, Dr. Cladel told the Father that outside environmental factors, such as stress, could result in the Child exhibiting symptoms that would mimic ADHD. The relationship between Mother and Father is strained, at best, and therefore the Child would greatly benefit by family counseling. It is admitted that the letter attached to Exhibit "B" is a true and correct copy of the original. 15. Denied. The characterizations of Father's position in this paragraph are denied. Father believes that the statements set forth in the letter are accurate. Further, Father has been attempting to act in the best interests of the Child. 16. Denied. After reasonable investigation, Father is without information or knowledge sufficient to form a belief as to the truth of the averments of this paragraph and therefore, the same are denied. By way of further answer, the statement of Dr. Cladel is dated March 13, 2006, and not March 23, 2006. 17. Admitted in Part and Denied in Part. It is admitted that Mother believes that the Child's condition has changed. Father cannot agree that the documents attached to Exhibit "C" are true and correct because Mother never provided them to Father until Mother filed her Petition. On information and belief, Mother has instructed the daycare center not to provide certain information to Father. In fact, on at least one 3 occasion, Father was provided with a sealed envelope by the daycare provider with instructions to give it to Mother and that Mother had instructed that the information not be provided to Father. Further, it appears that there are notations on the various documents contained in Exhibit "C" that are in the handwriting of Mother. 18. Denied. After reasonable investigation, Father is without information related to the averments in this paragraph, as Mother has not shared all information from the daycare provider with Father, and the same are therefore denied. 19. Admitted. It is admitted that Exhibit "D" is a true and correct copy of Dr. Cladel's letter. Father does not know what date Mother received the letter. Father received it on March 16, 2006, and attempted to call the doctor on or about March 17 to authorize a prescription for Methylin, but no one answered the doctor's telephone. By way of further answer, Dr. Cladel's letter states that he has been "following" the Child in his outpatient medication clinic. Father is not aware of any further office visits, nor is Father aware of how the Child could have been followed by a doctor if the doctor was in Chile. 20. Admitted. It is admitted that the letters that are attached as Exhibit "E" are copies of the originals. It is denied that Father used the word "trial", but it is admitted that Father asked the doctor for the test results that he performed, so that Father could consider further testing and a second opinion, if warranted. The results have not been provided to Father. 21. Admitted in Part and Denied in Part. Father has never "refused to consent to the prescription of ADHD medication", and the same is therefore denied. To the contrary, Father, looking out for the best interest of his son, agreed to further medication once the Child underwent appropriate testing and the parties engaged in counseling with the Child, as had been recommended verbally by the custody conciliator some months ago. Father further communicated this to the school personnel, who he thought was satisfied with his position. 22. Admitted. In fact, Father has asked Dr. Cladel in writing for the results of the tests (see Petitioner's Exhibit "E"). Father had also earlier requested this report through counsel (see Petitioner's Exhibit "B"). Father felt that he should obtain a copy 4 of Dr. Cladel's report in order to be able to give that report and test results to another physician. Dr. Cladel has not responded to these requests. 23. Denied as stated. Father is not a doctor, so Father does not know what testing should be performed. Father does not believe that any testing was done in his presence, and is unaware of any appointments that Mother and Child had with the doctor. Father simply believes that, before agreeing to a long-term prescription that the Child might have to take for many years, it is worth exploring other issues and getting a second opinion. For example, Dr. Cladel stated to Father that children who are very bright are often diagnosed with symptoms that mimic ADHD. Father also believes that outside factors such as stress could cause the child to exhibit ADHD symptoms. Father believes that it is worthwhile to perform additional testing to rule out these possibilities. 24. Admitted in Part and Denied in Part. Father has agreed that Child should take the ADHD medication until there is further testing and a second opinion. It may be that further testing and a second opinion will confirm the diagnosis. Father is simply asking for that opportunity in the best interest of the Child. Father also notes that there have been incidents while the Child was on the ADHD medication, which suggests that there may be other causes for the Child's behavior, in addition to or instead of ADHD, that should be explored. 25. Denied as stated. Mother has no reason to "fear" the Father. Father has been very clear that he is only interested in confirming the diagnosis and finding a proper treatment for the Child's on-going problems. It may be that the current diagnosis and treatment are correct. Father simply seeks the opportunity to confirm this before placing the Child on psychotropic medicine for an indefinite period of time. Mother has not attempted to discuss this matter with Father, but instead filed her Petition. 26. After reasonable investigation, Father is without information to form a belief as to the truth of these averments and the same are therefore denied. By way of further answer, Father works from his home. Father's wife is also at home and is currently not employed outside the home. Mother has never asked Father to share child care responsibilities when the Child has been at home. Father will gladly share this responsibility so that Mother does not need to use all of her sick and vacation days. 5 27. Admitted. By way of further answer, the Child was also diagnosed with allergies to grass, ragweed and dust mites. 28. Denied as stated. It is admitted that the report at Exhibit "F" is a true and correct copy of Dr. Zumoff's report. It is denied that all the recommendations of Dr. Zumoff are contained in this paragraph. To the contrary, Dr. Zumoff's report concluded with three recommendations. 29. Admitted in Part and Denied in Part. It is admitted that there is a dog in the Father's house. The dog belongs to Father's wife and step-children. It is denied that Father has "exposed" the Child to the dog. To the contrary, the dog is not allowed in the Child's bedroom and is kept away from the Child when the Child is in the home. Rooms where the Child spends his time are vacuumed before each visit, and Father has purchased air filters. The Child is also taking Singulair before he goes to his Father's home. All of these (with the exception of the air filters) are mentioned in Dr. Zumoff's report as being potentially helpful. Father has not noticed severe symptoms when the Child is with Father and the Child has not needed to use a nebulizer. 30. Denied as stated. It is admitted that the Child is taking Singulair before spending periods of time with his father. Father is doing everything possible to keep the Child and the dog separated, and believes that the Child is not having severe symptoms when in the presence of Father. 31. Admitted in Part and Denied in Part. It is denied that the Child is having allergic reactions to the dog, as those reactions are being controlled by the medicine prescribed by the Child's doctor. The child is taking his ADHD medication and the Father agrees to the Child continuing to take that medication while the Father is provided with a copy of Dr. Cladel's report and Father can seek a second opinion. It is admitted that the parties have not been able to agree on medication matters, but this is not due to Father's intransigence. Rather, it is because Father has real and appropriate concerns about the Child's health and well-being. 32. Denied. It is denied that Mother is entitled to attorneys fees as Father's conduct is not vexatious or arbitrary. Mother and Father are both incurring their own attorney's fees, and both are taking actions that they believe are in the best interest of the Child. Father had no way of knowing that Mother has used days off from work with 6 or without pay to care for the Child, as Mother has not asked that Father participate in this care, so Father should not be held responsible for lost wages. Father stands ready, wiling and able to provide care to the Child when the Child is not in daycare for whatever reason. WHEREFORE, Respondent respectfully requests that this Honorable Court enter an Order providing: a) that the Child remains on the medication Methylin in the near term; b) that Dr. Cladel provides both parties with complete copies of his medical records related to the Child; c) that Father select a physician to provide a second opinion, the cost of which will be divided between the parties to the extent not covered by insurance in the same proportions as their current support order; d) that Mother be directed to provide Father with copies of all reports from school, physicians and other care providers that have been delivered to Mother; e) that the parties shall attend family counseling with Dr. Arnold Shienvold for a period of not less than six months, and to follow the therapist's recommendation as to whether the counseling be individual, joint, and with or without the Child; f) that Mother shall notify Father when the Child does not attend daycare or school and give Father the first opportunity to care for the Child so that Mother does not have to use all of her vacation time or take unpaid time off from work; g) that the Father continue his efforts of keeping the dog away from the Child when the Child is in Father's home; and 7 h) that the parties shall each bear their own attorney's fees and costs, and that Mother's demand for lost wages be denied. Respectfully Submitted, WIX, WENGER & WEIDNER, P.C. By: David R. Getz, I.D.#34 38 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Respondent Date: ` > J ' F:\drg\3020 - Gajewski, Jahn\11486 - Domestic Relations\Documents\Answer to Petition for Special Relief.doc 8 1, John J. Gajewski, Respondent in the foregoing Answer, have read the foregoing Petition and hereby affirm and verify that it is true and correct to the best of my personal knowledge, information and belief. I verify that all of the statements made in the foregoing are true and correct and that false statements made therein may subject me to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. U John J. Gajewski, Respondent DATED: ti 2006 JOHN J. GAJEWSKI, IN THE COURT OF COMMON PLEAS OF. Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 02-1585 MARIE C. GAJEWSKI, : CIVIL ACTION -LAW Defendant : CUSTODY CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the foregoing Answer to Petition for Special/Emergency Relief in the above referenced matter via fax to (717) 975-0697 and via first class, U.S. mail postage prepaid to the following: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Respectfully submitted, WIX, WENGER & WEIDNER, P.C. r`. By::.7, David R. Getz, I.D.#3483K 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Respondent DATE: 10 .? -? ? ? ...x ',°?" . Y ? . . ' ? , a r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. GAJEWSKI, : NO. 02-1585 CIVIL TERM Plaintiff CIVIL ACTION - LAW v MARIE C. GAJEWSKI, Defendant IN CUSTODY ORDER AND NOW, this Court having been advised that the parties, Petitioner, Marie C. Gajewski ("Mother") and Respondent, John J. Gajewski, ("Father") have reached an agreement, IT IS HEREBY ORDERED AND DECREED as follows: 1. The child, Matthew C. Gajewski, ("Child") born October 18, 2001, will take such medication for ADHD as may be prescribed by Dr. Cladel. 2. Father may secure a second evaluation for the ADHD diagnosis of the Child to be performed at Father's sole cost and expense to the extent not covered by insurance. Mother shall cooperate with said evaluation. Said evaluation shall be performed by a child psychiatrist located within a 15 miles radius of Mother's residence, including the Hershey Medical Center. 3. The Order is entered without prejudice to either party as to any issues raised in the Mother's Petition or Father's Answer. ,41or % 7 2-00 G Distribution of this Order to: Attorney for Petitioner: Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011 - Attorney for Respondent: David R. Getz, Esquire, 508 North Second Street, Harrisburg, PA 17101 - - ??ffy ??yer RV TWrr rni IRT- Y? ? i ?i ,-i ?3, -,.7 __ 4M ?.. '3 JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, V. MARIE C. GAJEWSKI, Defendant. : NO. 02-1585 CIVIL TERM CIVIL ACTION - LAW PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of Defendant, Marie C. Gajewski in the above-captioned action. Richard C. Seneca, Esquire PA Supreme Court I.D. No. 49807 564 Old York Road Etters, PA 17319 (717) 932-0465 Date: June 16, 2008 CERTIFICATE OF SERVICE I hereby certify that a copy of the attached Entry of Appearance was served upon the following attorneys by depositing the same in the U.S. Mail, First Class, postage prepaid on June 16, 2008, at Etters, Pennsylvania: David R. Getz, Esquire Wix, Wenger & Weidner P.O. Box 845 Harrisburg, PA 17108-0845 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Richard C. Seneca, Esquire r i - L. . rT. I :> C .7 JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, : NO. 02-1585 CIVIL TERM V. CIVIL ACTION - LAW MARIE C. GAJEWSKI, Defendant. DEFENDANT, MARIE C. GAJEWSKI9S PETITION FOR SPECIAL RELIEF TO ALLOW CHILD TO ATTEND PRIVATE SCHOOL AND NOW, comes the Defendant, Marie C. Gajewski, to seek special relief from this Honorable Court in the form of an Order granting her request to allow Matthew C. Gajewski, a Minor, to attend Catholic school and in support thereof avers as follows: 1. This Honorable Court has exercised jurisdiction regarding the custody of Matthew C. Gajewski (hereinafter referred to as the "Child") since April 2, 2002. This case has previously been assigned to The Honorable Kevin A. Hess. 2. The Plaintiff-Respondent is John J. Gajewski (hereinafter referred to as the "Father"), the biological father of the Child. 1 3. The Defendant-Petitioner is Marie C. Gajewski (hereinafter referred to as the "Mother"), the biological Mother of the Child. 4. In its Order of Court, dated August 29, 2005, this Honorable Court ordered and directed that Father and Mother shall have shared legal custody of the Child and that Father and Mother shall have equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding his education and religion. A copy of the Order is attached hereto as Exhibit "A." 5. In its Order of Court, dated August 29, 2005, this Honorable Court ordered and directed that Mother shall have primary physical custody of the Child and Mother has exercised primary physical custody of the Child since his birth. 6. The Child was born on October 18, 2001, and is six (6) years of age. 7. Since the age of four (4) months, the Child has attended day care, including kindergarten, at a private school named and known as KinderCare Learning Centers situated at 730 Wertzville Road, Enola, Cumberland County, Pennsylvania. 2 8. Father has not objected to the Child's continued enrollment at the private school named and known as KinderCare and has contributed with the Mother to the tuition associated with the same. 9. The Child has not been placed in public pre-school education, including kindergarten, by the Mother and the Father has not petitioned this Honorable Court for the placement of the Child in a public pre-school educational program including kindergarten. 10. The Child is baptized in the Roman Catholic Church. 11. The Father is baptized in the Roman Catholic Church and attended Catholic school. 12. The Mother is baptized in the Roman Catholic Church and attended Catholic school including Good Shepherd School situated at 3400 Market Street, Camp Hill, Cumberland County, Pennsylvania. 13. Father regularly attends Roman Catholic Church and takes the Child to Roman Catholic Church on those Sundays and religious holidays in which Father has custody of the Child. 14. Mother regularly attends Roman Catholic Church and takes the Child to Roman Catholic Church on those Sundays and religious holidays in which Mother has custody of the Child. 15. The Mother has enrolled the Child in and the Child has regularly attended the Confraternity of Christian Doctrine classes, more commonly known as "C.C.D.," which is the religious education program of the Roman Catholic Church designed primarily for children. 16. Father has not objected to the Child's enrollment in and attendance at C.C.D. 17. Mother has enrolled the Child and has seen to the Child's attendance at C.C.D. in preparation for the Child's attendance at Catholic school. 18. As primary custodian of the Child, Mother has been responsible for and will continue to be responsible for all aspects of the Child's education including homework, school activities, and extracurricular school activities. 19. Mother desires that the Child attend Good Shepherd School in the fall of 2008 as a first grade student and that he continue a course of education at Good Shepherd School followed by Trinity High School. 20. Good Shepherd School is one of thirty-eight (38) Catholic elementary schools in the Diocese of Harrisburg and has been in existence since September 1, 1953. 4 21. Good Shepherd School serves students through eighth (8`'') grade in the Good Shepherd Parish Education Center which was constructed, adjacent to the original school, in August 2007 and offers enhanced science laboratory facilities, computer laboratory and state of the art technology in each classroom. 22. Good Shepherd School provides education in the following core areas: Mathematics, Science, Language Arts, Social Studies and Religion. Grades 1 through 4 are self contained and there is a heavy emphasis upon math and language arts. 23. At Good Shepherd School there is a full-time Learning Support teacher and additional support services are on-site to provide additional services in math, reading, language and counseling. The school faculty includes teachers, a school nurse, remedial math and reading instruction, guidance counseling, a speech clinician and a psychologist. 24. Good Shepherd School recognizes parents and teachers as co-partners in creating a positive learning atmosphere such as homework completion, participation in school activities and in extracurricular events. 25. The Child has been diagnosed with Attention-Deficit Hyperactivity Disorder ("ADHD") and by Order dated April 7, 2006, this Honorable Court ordered that the Child take such medication for ADHD as may be prescribed by his psychiatrist. A copy of the Order is attached hereto as Exhibit "B." 26. Good Shepherd School has numerous students who have been diagnosed with ADHD and has facilities, staff and an academic structure which is more than sufficient to accommodate students with this diagnosis. 27. The Child has thrived in attending a private, pre-school education program including kindergarten and it is the opinion of his teacher that the Child will continue to thrive in Catholic school and that such an environment will benefit the Child's educational needs, behavior and attention span. 28. The academic, social and spiritual structure and resources provided by Good Shepherd School as described above will provide the Child with the foundation upon which the Child requires to thrive in the elementary school setting and, as such, attendance at Good Shepherd School is in the best interests of the Child and the Child will benefit from attending Good Shepherd School. 29. Attendance at Good Shepherd School is consistent with the Father and the Mother's station in life in that both are Roman Catholic, both have enjoyed 6 the benefits of attending Roman Catholic School, and both actively participate in the Roman Catholic Church and include the Child in such participatory activities. 30. Father does not have any other biological or adopted children for whom he has a legal obligation to support. 31. Mother does not have any other biological or adopted children for whom she has a legal obligation to support. 32. Father and Mother have sufficient financial resources, including their income and earning potential, to pay for the tuition, fees and costs associated with the Child's attendance at Good Shepherd School since both have contributed to the Child's pre-school attendance at a private academic facility and both enjoy incomes which, taken together, are more than sufficient to pay the tuition, fees and costs associated with the Child's attendance at Good Shepherd School. 33. A private school education at Good Shepherd School is a reasonable need for the Child in that the Child will benefit from such education and private schooling is consistent with the family's standard of living and station in life before the separation and subsequent divorce of Father and Mother. 7 34. The Father will not approve of the Child attending Good Shepherd School under any circumstances. 35. The parties and their counsel have, over the last several months, attempted to amicably resolve Mother's fervent desire to send the Child to Good Shepherd School and Father's steadfast refusal to consent to the same. 36. It is believed and therefore averred that a conciliation conference will be to no avail and the Court intervention and adjudication of this issue is necessary to address singular issue of substantial impact upon the Child's life and well-being. 37. Time is of the essence in that Good Shepherd School is scheduled to commence on August 25, 2008. 38. The undersigned has informed counsel for the Father of his intent to file this Petition and counsel for the Father does not concur in the same. Wherefore, Defendant, Marie C. Gajewski respectfully requests that this Honorable Court enter an Order permitting Matthew C. Gajewski to attend Good Shepherd School in Camp Hill, Pennsylvania including it primary school and its after-school program and that the Plaintiff, John J. Gajewski and the Defendant, Marie C. Gajewski be ordered to contribute to the payment of the tuition, fees and 8 costs associated with the same in proportion to their net incomes. Respectfully submitted, Richard C. Seneca, Esquire PA Supreme Court I.D. No. 49807 564 Old York Road Etters, PA 17319 (717) 932-0465 Attorney for Defendant, Marie C. Gajewski 9 CE; i" D AJE 2 ,, JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v : NO. 02-1585 CIVIL TERM MARIE C. GAJEWSKI, : CIVIL ACTION - LAW Defendant : IN CUSTODY ORDER OF COURT AND NOW, this -2-? t day of , 2005, upon consideration of the attached Stipulation, it is ordered and directed as follows: 1. The Father, John J. Gajewski, and the Mother, Marie C. Gajewski, shalt have shared legal custody of Matthew C. Gajewski, born October 18, 2001. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decision affecting the Child's general well-being including, but not limited to, all decisions regarding his health, education and religion. Pursuant to the terms of this paragraph each parent shall be entitled to all records and information pertaining to the Child including, but not limited to, school and medical records and information. 2. The Mother shall have primary physical custody of the Child. 3. Until the Child's fourth birthday on October 18, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Saturday at 4:00 a.m. through Sunday at 5:00 p.m., beginning Saturday, May 21, 2005, and during weeks following the Mother's weekend periods of custody, on Monday from 4:00 p.m. until 6:00 p.m. The Father shall contact the daycare provider if he plans to pick up the Child prior to 4:00 p.m. 4. Beginning on October 21, 2005, the Father shall have partial physical custody of the Child on alternating weekends from Friday at 6:30 p.m. through Sunday at 4:30 p.m. and every Wednesday from 4:00 p.m. until 6:00 p.m. The Father shall notify the daycare provider in the event he intends to pick up the Child earlier than 4:00 p.m. 5. The parties shall share or alternating having custody of the Child on holidays as follows: A. Christmas: The Christmas holiday shall be divided into Segment A, which shall run from Christmas Eve at 6:00 p.m. through Christmas Day at 1:00 EXHIBIT "A" p.m., and Segment B, which shall run from Christmas Day at 1:00 p.m. through December 26 at 6:00 p. m. In odd numbered years, the Father shall have custody of the Child during Segment A and the Mother shall have custody during Segment B. In even numbered years, the Mother shall have custody of the Child during Segment A and the Father shall have custody during Segment B. In 2005, the Father shall also have custody of the Child from December 28 at 6:00 p.m. through January 1 at 4:00 p.m. In future years, the parties shall equally share the remaining school holiday break after Segment B, with the specific dates and times to be arranged by agreement between the parties. B. Alternating Holidays: The parties shall alternate having custody of the Child from 9:00 a.m. until 6:00 p.m. on Easter, Memorial Day, Independence Day, Labor Day and Thanksgiving Day each year. In even numbered years, the Father shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Mother shall have custody of the Child on Memorial Day and Labor Day. In odd numbered years, the Mother shall have custody of the Child on Easter, Independence Day, and Thanksgiving and the Father shall have custody on Memorial Day and Labor Day. C. Mother's Day/Father's Day: In every year, the Mother shall have custody of the Child on Mother's Day and the Father shall have custody of the Child on Father's Day from 9:00 a.m. until 6:00 p.m. D. The holiday custody schedule shall supercede and take precedence over the regular custody schedule. 6. Each party shall be entitled to have a one-week period of uninterrupted custody with the Child in 2005, upon providing at least 30 days advance notice to the other party. Periods of custody under this provision shall be scheduled from Friday through Friday and shall include each party's regular weekend period of custody. The party providing notice first shall be entitled to preference on his or her selection of vacation dates under this provision. The parties shall attempt to be reasonable in accommodating special scheduling needs for travel/rental schedules. Each party shall be entitled to have custody of the Child for two non- consecutive uninterrupted weeks beginning in 2006 and either party may request a review regarding expansion of the vacation schedule in future years. 7. In the event either party intends to remove the child from his or her residence for an overnight period or longer, that party shall notify the other party in advance and shall provide information concerning the address and telephone number where the Child can be contacted. 8. The non-custodial parent shall be entitled to have reasonable telephone contact with the Child with no interference or participation (listening in on the conversation) by the other party or third parties. 9. The parties shall cooperate in exchanging information regarding the Child in a civil and cooperative manner. 10. Unless otherwise agreed between the parties, exchanges of custody under this Order shall take place at the Bob Evans restaurant at the Swatara Exit off 1-283, with the exception of the weekday evening periods of custody, which shall take place at the River of God Church in Enola, Pennsylvania. 11. Neither party shall do or say anything which may estrange the Child from the other parent, injure the opinion of the Child as to the other parent, or hamper the free and natural development of the Child's love and respect for the other parent. Both parties shall ensure that third parties having contact with the Child comply with this provision. 12. This Order is entered pursuant to an agreement of the parties. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. BY THE COURT: J. Distribution to: David R. Getz, Esquire, 508 N. Second Street, Harrisburg, PA 17101, counsel for Father Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011, counsel for Mother r#R E COPY FROM RECfl U t-ld Um s" 01 1 TOW" w -W,1 jer.. unto W M hand W4 cq?" at ?, Pa. J Prothonotary JOHN J. GAJEWSKI, v MARIE C. GAJEWSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-1585 CIVIL TERM CIVIL ACTION - LAW Defendant : IN CUSTODY STIPULATION FOR ENTRY OF CUSTODY ORDER q - 7 M ? r j l C 0 AND NOW, this 104day of /1-0 q o t 2005, Marie C Ga jewski (`Mother") and John J. Gajewski, ("Father") hereby stipulate and agree to the entry of the foregoing Custody Order regarding custody of their minor child, Matthew c. Gajewski, born October 18, 2001, (the "Child"). IN WITNESS WHEREOF the parents, intending to be legally bound hereby, have set their hands and seals the day and year below written. WITNESS: (SEAL) MARIE C. GAJEWSKI Date: V114- /0- A (SEAL) JOH J. JEWSKI Date: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. GAJEWSKI, Plaintiff v MARIE C. GAJEWSKI, Defendant : NO. 02-1585 CIVIL TERM CIVIL ACTION - LAW IN CUSTODY ORDER AND NOW, this Court having been advised that the parties, Petitioner, Marie C. Gajewski ("Mother") and Respondent, John J. Gajewski, ("Father") have reached an agreement, IT IS HEREBY ORDERED AND DECREED as follows: 1. The child, Matthew C. Gajewski, ("Child") born October 18, 2001, will take such medication for ADHD as may be prescribed by Dr. Cladel. 2. Father may secure a second evaluation for the ADHD diagnosis of the Child to be performed at Father's sole cost and expense to the extent not covered by insurance. Mother shall cooperate with said evaluation. Said evaluation shall be performed by a child psychiatrist located within a 15 miles radius of Mother's residence, including the Hershey Medical Center. 3. The Order is entered without prejudice to either party as to any issues raised in the Mother's Petition or Father's Answer. W,Or% -? 2.006 Distribution of this Order to: Attorney for Petitioner: Diane G. Radcliff Esquire, 3448 Trindle Road, Camp Hill, PA 17011 - S?z, j-e^r?cL? 7 Attorney for Respondent: David R. Getz, Esquire, 508 North Second Street, Harrisburg, PA 17101 VJ EXHIBIT "B" RY T14F rnl IDT- VERIN TON I verify that the statements made in the foregoing Defendant, Marie C. GajewskiIs Petition for Special Relief to Allow Child to Attend Private School are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Marie C. Gajewski Dated: / _ 1 7 O r CERTIFICATE OF SERVICE I hereby certify that a copy of the attached Defendant, Marie C. Gajewski's Petition for Special Relief to Allow Child to Attend Private School was served upon the following attorneys by depositing the same in the U.S. Mail, First Class, postage prepaid on June q , 2008, at Etters, Pennsylvania: David R. Getz, Esquire Wix, Wenger & Weidner P.O. Box 845 Harrisburg, PA 17108-0845 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Richard C. Seneca, Esquire C',A V- •% JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, : NO. 02-1585 CIVIL TERM V. CIVIL ACTION - LAW MARIE C. GAJEWSKI, Defendant. PRAECIPE TO WITHDRAW APPEARANCE TO THE PROTHONOTARY: Please withdraw my appearance on behalf of Defendant, Marie C. Gajewski in the above-captioned action. Diane G. dcliff, Esquire PA Supreme Court I.D. No. 32112 3448 Trindle Road Camp Hill, PA 17011 (717) 737-0100 Date: ) 7 6 W410, -• CERTIFICATE OF SERVICE I hereby certify that a copy of the attached Praecipe to Withdraw Appearance was served upon the following attorneys by depositing the same in the U.S. Mail, First Class, postage prepaid on June 20, 2008, at Etters, Pennsylvania: David R. Getz, Esquire Wix, Wenger & Weidner P.O. Box 845 Harrisburg, PA 17108-0845 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Richard C. Seneca, Esquire PA Supreme Court I.D. No. 49807 564 Old York Road Etters, PA 17319 (717) 932-0465 Attorney for Defendant. r? µ 4, rNID y C JUN 2 32008 0"' JOHN J. GAJEWSKI, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, NO. 02-1585 CIVIL TERM V. MARIE C. GAJEWSKI, Defendant. : CIVIL ACTION - LAW RULE TO SHOW CAUSE AND NOW, this va3T4 day of June, 2008, upon consideration of Defendant-Petitioner, Marie C. Gajewski's Petition for Special Relief to Allow Child to Attend Private School, it is hereby Ordered that: (1) A Rule is issued upon Plaintiff-Respondent, John J. Gajewski to show cause why the Defendant is not entitled to the relief requested; and (2) The Rule is returnable at a hearing which shall be held on 2008, in Courtroom No. of the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. BY THE COURT: J. Distribution: / Z Richard C. Seneca, Esq., 564 Old York Road, Etters, PA 17319 t?David R. Getz, Esq., Wix, Wenger & Weidner, P.O. Box 845, Harrisburg, PA 17108-0845 (2d me c L, 1 L'Nn',, l a i:itSYY tJ 9 Z : ! 1 WV 9z NA ROOZ AbYiO ') ? C";';d 3HI JO Prepared by: David R. Getz, I.D.#34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Plaintiff JOHN J. GAJEWSKI, Plaintiff V. MARIE C. GAJEWSKI, Defendant IN THE COURT OF COMMON PLEAS OF. CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-1585 CIVIL ACTION -LAW CUSTODY ANSWER TO PETITION FOR SPECIAL RELIEF TO ALLOW CHILD TO ATTEND PRIVATE SCHOOL AND NOW, comes the Respondent, John J. Gajewski, by and through his attorneys, Wix, Wenger & Weidner, and files this Answer to the Petition for Special Relief of Marie C. Gajewski, as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4 Admitted in Part and Denied in Part. It is admitted that the Court Order of August 29, 2005 directs that Mother and Father shall jointly make major non-emergency decisions regarding the Child. It is denied that Father has had an equal voice relating to medical and educational decisions regarding the Child. In fact, Mother sought to enroll Child in Good Shepherd School without discussing her intentions with Father except through counsel. Mother has ignored Father's written concerns. 5. Admitted. 6. Admitted. 7. Admitted. 8. Admitted in Part and Denied in Part. It is admitted that the Child has been continuously enrolled in KinderCare. It is denied that Father has not objected to Child's enrollment. To the contrary, Mother enrolled Child in KinderCare without the prior consent and agreement of Father. Father objected by letter to Mother dated August 18, 2007, a copy of which is attached hereto as Exhibit "A" and is incorporated herein by reference. Mother ignored Father's concerns. It is further denied that Father has contributed to all of the expenses of KinderCare. Mother enrolled Child in the kindergarten portion of KinderCare in 2007 without consulting with Father. Father was relieved of the obligation to contribute to the cost of kindergarten as previously determined by an Order of this Court dated October 25, 2007, a copy of which is attached hereto as Exhibit "B" and is incorporated herein by reference. 9. Admitted with Clarification. It is admitted that Father has not petitioned this Honorable Court for the placement of the Child in a public pre-school educational program including kindergarten. By way of further answer, Mother unilaterally enrolled Child in a private kindergarten educational program without the prior consent and agreement of Father. Father believes it will serve the Child's best interest to be enrolled in a public school, namely West Creek Hills Elementary School in the East Pennsboro School District, for first grade. 10. Admitted. 11. Admitted. 12. Admitted. 13. Admitted. 14. Admitted. By way of further answer, Father believes and therefore avers that Mother does not attend Good Shepherd Parish; rather, she attends Our Lady of Lourdes Parish, which does not have a school. 15. Admitted. 16. Admitted. 2 17. Admitted in Part and Denied in Part. It is admitted that Mother has enrolled Child in the C.C.D. program through the Roman Catholic Church. It is denied that the Child's enrollment was in preparation for attendance at Catholic school. To the contrary, enrollment in the C.C.D. program is the last phase in completion of the religious education program before being confirmed by the Roman Catholic church and is not to prepare students for attendance in Catholic schools. By way of further answer, students in both public and private schools can be enrolled in the C.C.D. program. 18. Admitted in Part and Denied in Part. It is admitted only that Mother will be partly responsible for all aspects of the Child's education including homework, school activities and extracurricular activities. Father will share in that responsibility. By way of further answer, Father has not been advised of any school or extracurricular activities that the Child has been or will be enrolled, as Mother has failed to discuss those topics with Father. 19. Admitted in Part and Denied in Part. It is admitted that Mother desires that the Child attend Good Shepherd School in the fall of 2008 as a first grade student and that he continue a course of education at Good Shepherd School followed by Trinity High School. It is denied that this is in the best interest of the Child. It is also denied that this is the appropriate time to determine the Child's school attendance for the next 12 years. By way of further answer, to the best of Father's belief and knowledge, Mother has not adequately researched any other public or private school, their staff, programs, testing statistics or activities to discern that Good Shepherd School is in the best interest of the Child. On the other hand, Father has done research in the above areas and has spoken with staff at both Good Shepherd School and West Creek Hills Elementary School and believes that West Creek will serve in the best interest of the Child. Father and his wife, the step-mother of the Child, personally met with the staff of both schools. Father provided a written analysis of both schools to Mother, who has refused to discuss the subject with Father. A copy of Father's letter to Mother (without enclosures) is attached hereto as Exhibit "C" and is incorporated herein by reference. 20. Admitted. 21. Denied. After reasonable investigation, Father is without information or knowledge sufficient to form a belief as to the truth of the averments of this paragraph 3 and therefore, the same are denied. By way of further answer, it is denied that Good Shepherd School offers any more "enhanced" science laboratory facilities, computer laboratory facilities or state of the art technology in each classroom than those of West Creek Hills Elementary School. 22. Admitted in Part and Denied in Part. It is admitted that Good Shepherd School provides education in mathematics, science, language arts, social studies and religion. It is denied that Good Shepherd School offers any more "emphasis" in Grades 1 through 4 in mathematics and language arts than those at West Creek Hills Elementary School. By way of further answer, the public school provides education in those same subject areas except for religion. 23. Denied as stated. Father understands that there is not a full-time Learning Support teacher. Rather, the Learning Support teacher is present at Good Shepherd School only three (3) days per week and covers grades K through 8. All other support services are also part-time. Those support services are not provided by Good Shepherd School; rather, they are provided by the Capital Area Intermediate Unit. By way of further answer, West Creek Hills Elementary School offers those same services and has more full-time services. 24. Admitted with Clarification. It is admitted that Good Shepherd School recognizes parents and teachers as co-partners. By way of further answer, West Creek Hills Elementary School also recognizes parents and teachers as co-partners in creating a positive learning atmosphere. 25. Admitted. 26. Admitted in Part and Denied in Part. After reasonable investigation, Father is without information to determine whether or how many Good Shepherd School students have been diagnosed with ADHD, or how the staff accommodates students with this diagnosis. By way of further answer, West Creek Hills Elementary School has facilities, staff and an academic structure that are more beneficial to students with this diagnosis. 27. Denied. After reasonable investigation, Father is without information to form a belief as to the truth of these averments and the same are therefore denied. By way of further answer, there is no way to predict the Child's educational needs, behavior and 4 attention span based on spending one year in a private kindergarten program or that a Catholic school will be more any more beneficial in meeting any of the Child's educational or behavioral needs that that of a public school. 28. Denied. After reasonable investigation, Father is without information to form a belief as to the truth of these averments and the same are therefore denied. By way of further answer, Father is without any information that the Child will thrive better in a Catholic school setting or that a Catholic school setting is in any way more beneficial than that of a public school, or that a Catholic school is in the best interest of the Child. To the contrary, Father's research of and discussions with the staff at both schools lead him to conclude that the public school is more beneficial to the Child and will better serve the Child's best interest. 29. Denied. Although both parties are Roman Catholic and practice their faith, this does not lead to the conclusion that the Child should attend Catholic school. The Child can continue to attend C.C.D. classes to get religious education. By way of further answer, what is best for the Child religiously in the current instance is not relevant to what is best for the Child educationally. 30. Admitted in Part and Denied in Part. It is admitted that Father has no other biological children. It is denied that Father has no other financial obligations as he has two step-children. By way of further answer, Father is remarried and is providing partial financial support to his wife's two children even though he may have no legal requirement to do so. 31. Admitted. 32. Admitted in Part and Denied in Part. While it is admitted that Mother and Father have sufficient financial resources to pay for the costs associated with Child's attendance at Good Shepherd School, it is denied that money is or has been a factor in Father's decision to enroll Child at West Creek Hills Elementary School. To the contrary, Father's only concern is to enroll the Child in the school he believes will best suit the Child's needs. 33. Denied. After reasonable investigation, Father is without information to form a belief as to the truth of these averments and the same are therefore denied. By way of further answer, whether Child should attend Roman Catholic or public school has 5 nothing to do with standard of living or station in life. The parties were separated before the Child was born. Father's research of and discussions with the staff at West Creek Hills Elementary School and Good Shepherd School has led him to believe that the public school will be more beneficial to the Child and will better serve the Child's best interests. 34. Admitted. Father fervently believes that it is in the Child's best interest to attend public school. Father believes that ADHD students who attend public school instead of Roman Catholic school fare better because of the broader range of support services provided in public school. 35. Denied. It is admitted only that counsel have discussed this matter over the last several months. It is denied that Mother has been willing to discuss any aspect in determining which school will best suit the needs of the Child. Father has repeatedly asked for Mother's cooperation in reviewing research, materials, notes and documented discussions with the staff at West Creek Hills Elementary School and Mother has refused to cooperate or even discuss the issue with Father. Moreover, it is Father's belief that Mother has not looked at any other school besides Good Shepherd School that would provide better educational and behavior programs and activities for the Child. 36. Denied. Conciliation has worked well on several occasions in the past and the parties have been able to resolve other issues related to the custody of the Child without a hearing before this Court. 37. Admitted. 38. Admitted. WHEREFORE, Respondent respectfully requests that this Honorable Court enter an Order providing: a) that the Child be enrolled in West Creek Hills Elementary School for the 2008-2009 school year; b) that the parties shall attend and actively participate in family counseling with Arnold Shienvold or another therapist mutually agreeable to the parties for a period of not less than six (6) months, and to follow the therapist's recommendations as to whether the counseling be individual, joint, and with or without the Child; 6 C) that the parties shall each bear their own attorney's fees and costs. Respectfully Submitted, WIX, WENGER & WEIDNER, P.C. By: David R. Getz, I.D.#34838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Plaintiff Date: F:\drg\3020 - Gajewski, John\11486 - Domestic Relations\Documents\Answer to Petition for Special Relief for Education.doc 7 EXHIBIT "A" August 18, 2007 Ms. Marie Gajewski 99 Lee Ann Court Enola, PA 17025 Subject: Kindergarten for Matthew September 2007 Dear Marie: I am sorry that you did not consult with me on where Matthew would be attending Kindergarten this year. My understanding is that you are to consult with me regarding such important decisions as to where Matthew will attend school, health issues, and any other important matters regarding Matthew. I do not agree that Matthew should attend the program you've chosen at Kindercare. Per your note, it was necessary for me to contact Kindercare directly to find out the information you should have provided to me. Kindercare is a "Private Kindergarten" with a structured half-day of school. Matthew, if he were attending public school, would. be in school for a full day at West Creek Hills Elementary from 8:50 AM to 3:20 PM. Since Matthew will be 6 this year, I feel that a full day of school would be in his best interest. Matthew is very bright and I believe that you're holding him back by keeping him at Kindercare. Also, Kindercare's t/z day program and before and after school day care will be $194.00 per week. If Matthew were to attend the full day of public school, there would be no cost for school and before and after school day care could be provided by Kindercare for $118.00 per week with a bus picking Matthew up at his current day care and returning him at the end of the school day so it's even more difficult to understand why you made this choice. Another option would have been to enroll Matthew in the before and after school program at the public school (run by Mechanicsburg Learning Center) for an extra $80.00 per week which would have enabled him to spend time with some of his classmates and grow accustomed to his new school and his new friends. Not only do I feel that you are not providing Matthew with the best educational opportunity that he deserves, I also did not agree to pay the additional cost of a "private" program. School is scheduled to begin on August 28th at West Creek Hills and since you gave me no information what so ever, we are under a time crunch. I do plan on contesting your decision and the additional, and unnecessary, expenses as well. Based on your decision, I believe that Matthew will be behind many of his classmates next year. I continue to be very concerned that in your efforts to keep Matthew a "toddler", you are preventing the natural growth process and the milestones he should be reaching as a young boy. The fact that you still encourage Matthew to suck his thumb, have his "blankie", continuing to allow him to wear "pull-up at night and now you're preventing his progress as he enters school continues to be puzzling to me and harmful for Matthew's natural development process. Sincerely, John J. Gajewski Cc: David Getz, Esq. via e-mail EXHIBIT "B" In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MARIE C. GAJEWSKI ) Order Number 85 S 2002 Plaintiff ) VS. ) PACSES Case Number 048104212 JOHN J. GAJEWSKI ) Docket Number 00085 S 2002 Defendant ) Other State ID Number ORDER OF COURT 0 Final ® Interim 0 Modified AND NOW, 25TH DAY OF OCTOBER, 2007 based upon the Court's determination that the Payee's monthly net income is $ 3,217.98 and the Payor's monthly net income is $ 4,182.17 , it is hereby ordered that the Payor pay to the Pennsylvania State Collection and Disbursement Unit ONE THOUSAND AND XX/100 Dollars ($1, o o o . o o ) a month payable MONTHLY as follows: first payment due IN ACCORDANCE WITH THE DEFENDANT'S CURRENT PAY SCHEDULE. The effective date of the order is 0 9 / 13 / 0 7 . Arrears set at $ 5 9.7 8 - as Of OCTOBER 25, 2007 are due in full IMMEDIATELY. All terms of this Order are subject to collection and/or enforcement by contempt proceedings, credit bureau reporting, tax refund offset certification, driver's license revocation, and the freeze and seize of financial assets. These enforcement/collection mechanisms will not be initiated as long as obligor does not owe overdue support. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all the means listed above. For the Support of: Name Birth Date MATTHEW CHRISTIE GAJEWSKI 10/18/01 Form OE-518 Rev. 3 Service Type M Worker ID 21101 GAJEWSKI V. GAJEWSKI PACSES Case Number: 048104212 The defendant owes a total of $ 1, 0 0 0.0 0 per month payable MONTHLY ; $ 952.00 for current support and $ 48.00 for arrears. The defendant must also pay fees/costs as indicated below. This order is allocated and monies are to be applied as follows: Frequency Codes: Payment Amount/ $ 952.00 /M $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / $ 0.00 / I =One Time M =Monthly TAT crr' ion n .fi i r? CS ALLOC/MED MATTHEW CHRISTIE GAJEWSKI Said money to be turned over by the Pa SCDU to: MARIE CHRISTIE GAJEWSKI . Payments must be made by check or money order. All checks and money orders must be made payable to Pa SCDU and mailed to: Pa SCDU P.O. Box 69110 Harrisburg, Pa 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Page 2 of 4 Form OE-518 Rev. 3 Service Type M Worker ID 21101 GAJEWSKI V. GAJEWSKI PACSES Case Number: 048104212 The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed medical expenses of the obligee or children that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31st of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 55 % by defendant and 4 5 % by plaintiff. Q Defendant ® Plaintiff Q Neither party to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the ® Plaintiff Q Defendant shall submit to the person having custody of the child(ren) written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of : 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. Other Conditions: Defendant shall pay the following fees: $0.00 fOr JUDICIAL COMPUTER FEE Payable at $ 0.00 per MONTH $ 0.00 fOr COURT COSTS Payable at $ 0 . 00 per MONTH $0.00 for Payable at $ 0 . o 0 per $ 0.00 for Payable at $ 0 . o o per $ 0.00 for Payable at $ 0 . o o per Page 3 of 4 Form OE-518 Rev. 3 Service Type M Worker ID 21101 GAJEWSKI V. GAJEWSKI PACSES Case Number: 048104212 IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED that, upon payor's failure to comply with this order, payor may be arrested and brought before the Court for a Contempt hearing; payor's wages, salary, commissions, and/or income may be attached in accordance with law; this Order will be increased without further hearing by o % a month until all arrearages are paid in full. Payor is responsible for court costs and fees. Copies delivered to parties 0IdIDA) Date Consented: Plaintiff Defendant DRO: Todd Moul cc: plaintiff and defendant cc: David Getz, Esq. cc: Diane Radcliff, Esq. Plaintiff s Attorney Defendant's Attorney BY THE CO Page 4 of 4 Service Type m '' I , Judge Form OE-518 Rev. 3 Worker ID 21101 In the Court of Common Pleas of cuMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 DAVID R. GETZ, ESQ. C/O WIX, WENGER & WEIDNER 508 N SECOND ST PO BOX 845 HARRISBURG PA 17108-0845 Fax: (717) 240-6248 OCTOBER 25, 2007 Distribution Cover Letter Plaintiff Name: MARIE C. GAJEWSKI Defendant Name: JOHN J. GAJEWSKI PACSES Case Number: 048104212 Please note: All correspondence must include the PACSES Case Number. Dear DAVID R. GETZ, ESQ. Please note the attached document and/or correspondence. This information is being sent to update you on the above captioned case. Sincerely, TODD A. MOUL Form CM-520 Service Type M Worker ID 21101 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION PACSES Case Number: 04 8104 212 Docket Number: 00085 S 2002 Other State ID Number: Please note., All correspondence must include the PACSES Case Number. OCTOBER 25, 2007 SUMMARY OF TRIER OF FACT Plaintiff Information Defendant Information MARIE C. GAJEWSKI JOHN J. GAJEWSKI Address: 99 LEE ANN CT ENOLA PA 17025-1937 Employer: PINNACLE HEALTH PO BOX 8700 HARRISBURG PA 17105-8700 Address: 1 FIELD LN LITITZ PA 17543-7934 Employer: INTRA CORP 1601 CHESTNUT ST IL42G PHILADELPHIA PA 19192-000 Attorney: Attorney: DIANE G. RADCLIFF, ESQ. DAVID R. GETZ, ESQ. O Complaint for Support ® Petition for Modification Filed 09/13/07 D Other Reason for Conference: DEFT FILED PETITION TO REDUCE Dependent(s) MATTHEW CHRISTIE GAJEWSKI 10/18/01 182-80-7881 Current Order: $984.00 Service Type M / per month Form CM-022 v1 Worker ID 21101 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION PACSES Case Number: 048104212 Docket Number: 00085 S 2002 Other State ID Number: Please note: All correspondence must include the PACSES Case Number. OCTOBER 25, 2007 SUMMARY OF TRIER OF FACT Plaintiff Information Defendant Information MARIE C. GAJEWSKI JOHN J. GAJEWSKI Address: 99 LEE ANN CT ENOLA PA 17025-1937 Employer: PINNACLE HEALTH PO BOX 8700 HARRISBURG PA 17105-8700 Attorney: DIANE G. RADCLIFF, ESQ. Address: 1 FIELD LN LITITZ PA 17543-7934 Employer: INTRA CORP 1601 CHESTNUT ST IL42G PHILADELPHIA PA 19192-000 Attorney: DAVID R. GETZ, ESQ. ? Complaint for Support ® Petition for Modification Filed 09/13/07 ? Other Reason for Conference: DEFT FILED PETITION TO REDUCE Dependent(s) MATTHEW CHRISTIE GAJEWSKI 10/18/01 182-80-7881 Current Order: $984.00 Service Type m / per month Form CM-022 v1 Worker ID 21101 GAJEWSKI V- GAJEWSKI PACSES Case Number: 048104212 Other Information (continued): THAT THE COST OF CHILD CARE BE BASED ON THE CHILD ATTENDING THE FULL DAY PUBLIC KINDERGARTEN WITH BEFORE AND AFTER SCHOOL CARE AT THE CURRENT CHILD CARE FACILITY AT A COST OF $118.00 PER WEEK. Facts Agreed Upon: Facts in Dispute and Contentions with Respect to Facts in Dispute: Guideline Amount: $ 9 5 2.0 0 / MONTH DRS Recommended Amount: $ 952 00 /MONTH DRS Recommended Order Effective Date: 09/13/07 Parties to be Covered by Recommended Order Amount: ONE CHILD. Guideline Deviation: Q YES or ® NO Reason for Deviation: Submitted by: TODD A. MOUL Date Prepared: OCTOBER 25, 2007 Page 3 of 3 Form CM-022 vl Service Type M Worker ID 21101 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240.6225 Fax: (717) 240-6248 Plaintiff Name: MARIE C. GAJEwsxl Defendant Name: JOHN J. GAJEWSKI Docket Number: 00085 s 2002 PACSES Case Number: 048104212 Other State ID Number: Please note: All correspondence must include the PACSES Case Number. CHILD SUPPORT 1. Number of Dependents in this Case 2. Total Gross Monthly Income 3. Less Monthly Deductions 4. Monthly Net Income 5. Combined Total Monthly Net Income 6. Plus Monthly Social Security Benefit for Child/Children 7. Adjusted Monthly Net Income 8. Basic Child Support Obligation 9. Basic Child Support Less Monthly Social Security f Child/Child B f ene ren it or 10. Net Income as Percentage of Combined Amount 11. Each Parent's Monthly Share of the Basic Child Support Obligation 12. Adjustment for Shared Custody 13. Adjustment for Child Care Expenses 14. Adjustment for Health Insurance Premiums 15. Adjustment for Unreimbursed Medical Expenses 16. Adjustment for Additional Expenses 17. Total Obligation with Adjustments 18. Less Split Custody Counterclaim 19. Obligor's Support Obligation Service Type M Support Guideline Calculation Defendant 00 $ 5,252.22 $ 1,070.05 $ 4,182.17 Plaintiff of $ 4,082.79 $ 864.81 $ 3,217.98 $ 7,400.15 S $ 7,400.15 $ 1,172.00 $ 1,172.00 56.51 %- $ 662.30 43.49 % $ 509.70 $ $ 261.49 $ 28.50 $ 952.29 $ 0.00 $ 952.29 Form OE-019 Worker ID 21101 GAJEWSKI V. GAJEWSKI PACSES Case Number: 048104212 Summary Date: OCTOBER 25, 2007 Monthly obligation amount selected: $ 952.29 Payment frequency: MONTHLY Obligation amount: $ 952.29 Deviation reason: 1. 2. 3. 4. 5. Page 2 of 2 Form OE-019 Service Type M Worker ID 21101 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MARIE C. GAJEWSKI ) Docket Number 00085 S 2002 Plaintiff ) VS. ) PACSES Case Number 048104212 JOHN J. GAJEWSKI ) Defendant ) Other State ID Number NOTICE OF RIGHT TO REQUEST A HEARING The parties are hereby advised that they have until NOVEMBER 15, 2007 to request a hearing de novo before the Court. File requests in person at: DOMESTIC RELATIONS SECTION 13 NORTH HANOVER STREET CARLISLE PA 17013 or mail to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M Form OE-572 Worker ID 21701 EXHIBIT "C" • John J. Gajewski 1 Field Lane Lititz, PA 17543 May 5, 2008 Ms. Marie Gajewski 99 Lee Ann Court Enola, PA 17025 Re: Matthew Gajewski/ Fall 2008 School Marie: I am in receipt of Attorney Richard Seneca April 18, 2008, letter to Attorney Getz. Your, attorney addresses several issues which I will attempt to answer for you in my letter. I had previously written you on August 18, 2007, and informed youthat I was not in favor of Matthew attending private school and I outlined several reasons why I felt attendance there would not be in Matthew's best interest. My feelings have not changed; if anything they have been reinforced after recently visiting both the Catholic school and the elementary school. Attorney Seneca mentions that I attended parochial school and although that is true, I had little to say about the selection process. This was a decision made by my parents andin.,part the decision was made to be?able to attend a religious school because there was no . a additional cost. While I enjoyed the added religious ;,aspect of the school,"I do not feel that I receiveda better education. Also, the way in which discipline issues were handled has. left behind some-emotional scars: Although I know thatthe.way, in which those issues are now handled has changed, I still have some concerns: Attorney Seneca indicates that Matthew regularly attends Confraternity of Christian Doctrine classes. I taught CCD for 5 years and I support this venue of teaching Matthew about his faith after school or on the weekend, whatever works best for your schedule. I strongly believe that while in school, emphasis should be placed on traditional learning with religious education encouraged and taught at home along with his CCD program. In the interest of Matthew, I did recently visit both the Catholic Good Shepard Elementary School as well as the West Creek Hills Elementary School (the public school Matthew would attend) and I listened openly to what each had to offer in order to objectively evaluate both programs. At Good Shepard, I met with Ms. Leslie Cwalina, Office Administrator, and Mr. Bowe's, the Principal. At West Creek Hills Elementary, I met with Mrs. Statler, the Guidance Counselor. The focus of my visit was to evaluate both schools' offerings to determine which school was programmatically superior and could best meet Matthew's ADHD needs in the classroom. According to Map Quest, West Creek Elementary School (WCES) is a bit closer to Matthew's home in Enola than Good Shepard School (GSS). WCES is located in a 0 • residential area while GSS is located on a busy road leading to many businesses and large strip malls. GSS is a new school but WCSE was totally renovated within the last seven years. GSS has a large field with no sports or recreation equipment outside leaving no real playground for keeping young children as physically challenged at recess. It's also to the side of the school and monitored, in part, by volunteer parents. Again, it is very close to a heavily traveled road. WCHE offers several basketball hoops and a full playground with swings, etc. WCSE offers a 20-minute outside recess (weather permitting), supervised by at least 4 staff. The playground is completely fenced in and located in the back of the school providing further safety. Both schools have limited their class size to 20 students per class. GSS has a total of 14 teachers; for grades K through 8, five of which are Masters Level. There are between 25 to 30 full time teachers at WCHE (K through 4) and many currently hold their Master's or have completed or are completing coursework towards their Masters in Education. All the First Grade teachers have, their Masters degree at the public school. Both schoois;have a. full time Registered Nurse on.staff However, they only have one part-time aide at the Catholic school for grades K through 8 whereas the public school has a Student Services Counselor who works directly with children who have ADHD as well as several aides; The Student Service Counselor works with the teacher, the parerits, and the student to develop an individualized education plan. The principal at GSS openly + _.. admits .that :they -have limited ability to deal with ADHD. students°and they rely on the a ; .. teacher's themselves. to solve the in-classroom .issues: They. eat ADHD students in the ,,,front of the.classroom and try to address any issues.by cuFing:signals. If Matthew were { too disruptive. at GSS ,in. the classroom, .he tmay have to go to the principal's office or he ?.a . might have to stay in at recess in order to try to: address any needs., If Matthew were disruptive at WCHE, the Student Services Counselor would come into the classroom and work with Matthew one on one to solve any issues and if that didn't work, she would take him to her office to quietly complete his work. The Principal at GSS said, "It's too bad but a kid with ADHD never reaches his full potential but hopefully, he might grow out of it". The guidance counselor at WCHE said, "ADHD is not a disability but just a child that functions at a different level, sometimes a higher level, than their classmates". Without indicating who exactly uttered the statement about kids not reaching their full potential with ADHD, Ms. Statler indicated you better not tell Leslie (Student Services Counselor) that; she has ADHD herself and is now finishing her Ph. D. She understands, first hand, how to effectively harness the power of ADHD and assist kids in reaching their full potential. GSS utilizes their gym for lunch, physical education classes and assemblies. Children have a catered hot lunch October thru May otherwise they can brown bag lunch. WCHE utilizes their gym for physical education or for assemblies. They offer a breakfast program, 4 different daily lunches or the student can brown bag lunch. n LJ • WCHE has a full time art teacher, along with a separate art room, featuring a pottery kiln and art is offered two times per week; GSS offers art once per week with no extra amenities and no specific art room. Physical education is offered once per week at GSS but is offered twice per week at WCHE with a swimming program offered for 11 weeks each year. Also, WCHE offers foreign language by 5`h or 6th grade (the counselor was unsure) however, foreign language is not offered at GSS which goes through grade 8. GSS has a computer room and children utilize this area once per week. Only the teacher has an in-classroom computer at the Catholic school. WCHE has the advantage of offering children use of a computer lab for a full semester each year. Each classroom also houses three computers for student use. As you can see from all my information gathering; West Creek Hills Elementary School. would be the best choice, in my opinion, for our son; Matthew I believe along with Matthew's ADHD needs; as well as his anxiety,.that-WestCreek Hills will better address both his educational needs and his medical issues and will allow him every possible opportunity to excel in his future school years as well. I understand that GSS has great.: - test scores each year in the IOWA category but rest assured, West Creek Hills Elementary School has won an award EVERY year for their academic excellence: Marie,•:I'm;unsure.-if:you have taken atour of the public elementary school as well but-:if }.- s, a not I would urge her to do so. Sending, your child, off to elementary school for the first time .can feel overwhelming as a parent because you're looking for the best possible experience for your., child. I feel very assured after visiting::both the catholic and the -public school that it is ;in our son, Matthew's bust !interest on all levels toz attend. West Creek Hills Elementary School. Sincerely, ohn J. ajewski Enclosures I, John J. Plaintiff, Respondent In the foregoing Answer, have read the foregoing Petition and hereby affirm and verify that it is true and connect to the best of my personal knowledge, information and belief. I verify that all of the statements made in the foregoing are true and correct and that false statements made therein may subject me to the penalties of 18 Pa.C.S.A. Section 4904, relating to unswom - falsification to authorities. OX L o n J. G j ski, Plai l DATED:J J( I'- -, 2008 JOHN J. GAJEWSKI, IN THE COURT OF COMMON PLEAS OF. Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 02-1585 MARIE C. GAJEWSKI, CIVIL ACTION - LAW Defendant CUSTODY CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the foregoing Answer to Petition for Special Relief in the above referenced matter via first class, U.S. mail postage prepaid to the following: Richard C. Seneca, Esquire 564 Old York Road Etters, PA 17319 Respectfully submitted, WIX, WENGER & WEIDNER, P.C. By: David R. Getz, I.D.#3 838 508 North Second Street P.O. Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 Attorney for Plaintiff DATE: ?JI?-, L5 'Pd p r? ? ? a JOHN J. GAJEWSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 02-1585 CIVIL MARIE C. GAJEWSKI, Defendant IN CUSTODY IN RE: PETITION FOR SPECIAL/EMERGENCY RELIEF ORDER AND NOW, this 2 ' day of July, 2008, after hearing, it is ordered and directed that the child, Matthew C. Gajewski, may attend Good Shepherd School, including its after- school program, and that mother and father contribute to the payment of the tuition, fees and expenses associated with the same. This matter is referred to the Domestic Relations Office for the purpose of allocating the expenses between the parties in proportion to their net income and in accordance with Pa.R.C.P. 1910.16-6(d). BY THE COURT, Kevin X. Hess, J. David R. Getz, Esquire For the Plaintiff ? Richard Seneca, Esquire For the Defendant Domestic Relations Office :rlm Ce. (.es r-h v t LL 7?a ? /erg 6c:c /.J Vt L S£:01Wv iz wcool