Registration Form for the Helping Children Succeed After Divorce Seminar

Your registration will be confirmed and completed when the Parent Education Department contacts you with the seminar location and directions.

Confirmation is required for seminar admittance.

Name (as listed on case):

Court Case Number:

(Enter Format: YYYY XX 00000 )
[If you don't have or forget the Court Case Number, please call 225-5412]

Daytime Telephone Number:

(Area Code-999-9999)

E-mail Address:

Date and Time of Seminar you wish to attend:

Alternate Date and Time of Seminar you wish to attend:

Would you feel comfortable attending the seminar
with the other parent?

Comments: