DR Pre-registration Form

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:	[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:	2008 Seminar Schedule

Alternate Date and Time of Seminar you wish to attend:	2008 Seminar Schedule

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