Enroll - ACT For The Children

Enroll and pay online.

Once you have submitted your form, please check your email, including your spam folder for confirmation and future emails.

Enrollment is closed 5 days before each class to allow for adequate processing time.

Classes are held Thursday evenings and Saturday mornings and will be in an online format until social distancing is no longer required. Use of a camera for online classes is required.

Enrollment Form

Full Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Phone
Cell Phone
Work Phone
Email *
Fax
Preferred Method of Receiving Information *
US Postal MailEmailFax
Name of Child(ren)'s Other Parent *Class size is limited. Parents are enrolled in order that application is received. You cannot be placed in the same class as your child(ren)’s other parent.
Class Selection Request Separating parents cannot participate in the same session and registrations will be processed in the order they are received. Following this registration request you will receive a confirmation email or letter confirming which date you have been placed in. That letter will also include the class location. You are not enrolled until you receive this confirmation.
Thursday Classes 4:00 pm – 8:30 pm November 19th, 2020, February 25th, 2021, April 22nd, 2021, June 17th, 2021, August 19th, 2021, October 21st, 2021
Saturday Classes 8:30 am – 1:00 pm January 23rd, 2021, March 20th, 2021, May 8th, 2021, July 31st, 2021, September 18th, 2021, November 13th, 2021
Class Selection - First Choice *Please enter the session you prefer to attend.
Class Selection - Second Choice *Please enter an alternate session request in the event you cannot be placed in your first choice.
Are you currently in danger? *
Are you currently in danger of your partner or ex-partner doing any of the following: (1) Physically hurting you by, for example, pushing, grabbing, slapping, hitting, choking or kicking? OR (2) Threatening to hurt you, your children or someone close to you? OR (3) Stalking, checking up on you or following you? OR (4) Making you afraid?Yes - you will be contacted by the program administrator. Please indicate the safest way to contact you below.No - None of the above applies to me or I choose not to answer these questions at this time.
If you answered yes to the question above, please list the safest way to contact you.
Is your case currently in court? If your case is currently in court, please complete the information below.
Are you being represented by legal aid? *
YesNo
If yes, please provide the name of your legal aid attorney. If no, please put N/A. If you are being represented by legal aid, it is not necessary to complete the Scholarship Application for ACT.
Judge's Name
Family Court File Number
Supreme Court Index Number
Payment Instructions Class registration is $100. When you click submit below, you will be directed to a payment checkout page.

Verification

Please enter any two digits *Example: 12
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For Scholarship Applicants Only

When you click Submit, your enrollment form will be sent to the ACT Administrator. You do not need to complete the payment section for your registration to be received.

Enrollment Form

Verification

*For Scholarship Applicants Only*

When you click Submit, your enrollment form will be sent to the ACT Administrator. You do not need to complete the payment section for your registration to be received.

For Scholarship Applicants Only