8-Week Parenting Class Registration Form

Your Name:*

First NameLast Name

Email*

Phone Number*

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Please indicate how you would like your name printed on your certificate if different than above.

Please provide your co-parent's name below:*

This is a co-parenting class that you will be taking with your co-parent, please provide their name.

If court is involved, when is your next hearing?

Date

Attorney Information (If applicable):

Is there an active restraining order in your case? (If there is, you will need to register for another co-parenting class)*

YesNo

Do any of your children have special needs?*

YesNo

How long have you been separated from you ex?*

Where you married to each other?*

YesNo

If yes, is the divorce finalized?

Do you share 50/50 physical custody?*

YesNO

How often are you kids with you?*

Do you share 50/50 legal custody? ( Share responsibility of making legal decisions for your children- such as therapy, schooling, education, etc.)*

YesNo

Are your children in therapy?*

YesNoThey see a school counselorI don't know

What is the biggest issue you are having with your co-parent?*

Are there any additional issues you would like us to know about?*

How do you and your co-parent communicate? Choose all that apply.*

Are you court ordered to take this class?*

YesNo

Is there an active restraining order in place right now?*

YesNo

If yes, please attach a copy of the restraining order.

Is Child Protective Services (CPS) involved in your case? If so, please enter your social workers name, email and phone number.*

What would you like to gain from this program?*

IMPORTANT INFORMATION:

CLASS GUIDELINES:

1. Civil Communication:
-Commit to communicating in a civil and non-confrontational manner throughout the class.
-Avoid inflammatory language, accusations, or personal attacks during interactions.

2. Minimal Engagement:
-Strive to minimize direct interactions if past conflicts suggest they may escalate.
-Focus on the class content rather than engaging in personal disputes.

3. Time Management:
-Adhere to the class schedule and respect the instructor's guidance on time limits for discussions.
-Keep sharing within reasonable time frame to maintain a productive learning environment.

4. Conflict Avoidance:
-Prioritize conflict avoidance during class sessions by refraining from engaging in contentious topics.
-Notify the instructor if conflicts arise to address them appropriately and ensure the safety of all participants.
-Respect each co-parent's right to express their thoughts without interruption or criticism.
-Avoid diminishing the input of the other co-parent during discussions.

5. Confidentiality:
-Respect the confidentiality of all participants by refraining from discussing personal disclosures outside of the class.
-Maintain the privacy of other attendees to foster trust and respect within the class.
-Note that the class is confidential, and no reports or documentation will be provided for court purposes. Furthermore, instructors will not testify in court proceedings based on information shared during the sessions.
-All instructors at CoParenting Solutions are mandated child abuse reporters, ensuring the safety and well-being of all participants. In cases of suspected child abuse or neglect, the appropriate authorities will be notified as required by law.

6. Attendance Conditions:
-Ensure that NO CHILDREN or THIRD PARTIES are present or in the same room during class sessions.
-Dress appropriately and have your camera on for the entire duration of the class, ensuring that you are clearly visible in front of the camera view, to facilitate effective communication and engagement.
-If you are 15 minutes or more late to class, you will not be admitted, and you will not receive credit for attendance.
-If you miss 1 class, you may make it up at the end of the 6 weeks, but there is a $65 mandatory makeup class fee.
-Missing 2 classes or more will result in being dropped from the class.

7. Limit Distractions:
Minimize distractions during class by refraining fom activities such as walking around, watching TV, cooking, shopping, etc.

8. Commitment to the Course:
-Recognize that this is a 6-week commitment and plan accordingly to be prepared, on-time and full engaged in class discussions.

By signing below, you acknowledge that you have read and understood the course guidelines and agree to comply with all class policies. Failure to adhere to these guidelines may result in removal from the class and failure to complete the course.

Signature*

Please select one of the payment options*

Full PaymentCovers the entire cost of the program sessions 1-6.

$335.00 Quantity

Half PaymentCovers sessions 1-3

$167.50 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

6-Week Collaborative Co-Parenting Course Registration Form

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