Enroll Enroll and pay online. Enrollment FormTitle First *Last *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone Cell Phone Work Phone Email *Fax Preferred Method of Receiving Information *US Postal MailEmailFaxName 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 January 9th, March 19th, May 21st, July 16th, September 17th, November 19thSaturday Classes 8:30 am – 1:00 pm February 15th, April 25th, June 20th, August 15th, October 17thClass 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.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 Square payment checkout page. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
