Who fills out this form?

The form has sections for Petitioner/Joint Petitioner A, Respondent/Joint Petitioner B, and Non-parent signatures, meaning both parents and any non-parent involved can sign it.

Does this form cover child support?

The form includes a section stating that child support cannot be changed in this agreement and must be handled separately.

Is this agreement permanent?

The parties agree that the terms of this agreement are temporary and will end on a specific date or after the deploying parent returns.

FA-4189V

Agreement Granting Temporary Custodial Responsibility and/or Visitation during Deployment

Wisconsin · Wisconsin Court System · Effective June 2, 2022

This form is an agreement used to set temporary rules for who has care of the children and when the parents can see them while one parent is deployed. It covers temporary legal custody, physical placement, and visitation during the deployment period.

The court describes it as: Agreement Granting Temporary Custodial Responsibility and/or Visitation during Deployment.

Open the official PDFfrom Wisconsin Court System

Where this fits in a case

Motions

Start a case
Respond
Motions
Discovery
Hearing
Judgment
After judgment
Appeal

Stage: Motions

This form is used when parents need to write down temporary agreements about child care and visitation because one parent will be deployed for a set time.

Either party may file.

Official instructions

How-to guides published by the court for this form.

Plain-language summary

Common questions

Who fills out this form?: The form has sections for Petitioner/Joint Petitioner A, Respondent/Joint Petitioner B, and Non-parent signatures, meaning both parents and any non-parent involved can sign it.
Does this form cover child support?: The form includes a section stating that child support cannot be changed in this agreement and must be handled separately.
Is this agreement permanent?: The parties agree that the terms of this agreement are temporary and will end on a specific date or after the deploying parent returns.

Revision history

No changes recorded since we started tracking this form on October 10, 2026. The current version took effect June 2, 2022.

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