Register for Parent Education Program - Catholic Charities Archdiocese of Hartford

Please Confirm Your Requested Class Date *

Location *

First Name *

Last Name *

Street Address 1

Street Address 2

City

US States

Zip

Phone *

Email *

How did you hear about us?

You have the right to attend the class together or separate from any individual. Is there anyone who you do NOT want to attend the same class as you? *

Yes, I do not want a specific person attending the class with me.

No, I have no preferences who attends the same class.

Have there been any safety concerns or domestic violence issues between you and your child(ren)’s other parent? *

Yes, there are there have been safety concerns or domestic violence issues.

No, there have not been safety concerns or domestic violence issues

Are there currently any active restraining orders, protective orders or no contact orders for either parent? *

Yes, there are restraining/protective/no-contact orders

No, there are not any restraining/protective/no-contact orders

(Le llamaremos para registrarle) *

Do you need a class taught in Spanish?

No

Sí (Yes)

Do you have any special needs to assist you in attending the class? *

Yes, I have special needs for attending the class

No, I do not have any special needs for attending the class

By checking this box, you agree that you have read and understand the statement below. *

I understand that filling out this form does not guarantee me a spot in any specific Parent Education Class. An email will be sent confirming that payment and registration are complete prior to the day of your class. If the requested class is not available, you will be provided with alternative classes by phone or email. Cost is $150 and payment is due in advance. We accept credit cards, cash and money orders. Thank you.

I Agree that I have read and understand.

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