PARENT SEMINAR REGISTRATION

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Pre-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 Tina Kavy 225-4092]
 
Daytime Telephone Number:  (Area Code-999-9999)
E-mail Address:
 
Date and Time of Seminar you wish to attend:
  2015 Seminar Schedule
 
Alternate Date and Time of Seminar you wish to attend:
  2015 Seminar Schedule
 
Would you feel comfortable attending the seminar 
with the other parent?
Comments: