Back to All Events Middletown/GD Saturday, January 20, 2018 9:00 AM 4:00 PM Gilead Community Services 230 Main Street Extension Middletown, CT, 06457 United States (map) Google Calendar ICS Parent Education Program Class Description: No additional details. Call with Questions Inquire by Email Register Online PEP Registration Name * First Name Last Name Email Address * Street Address * Apartment or Unit # City/Town * If you are not a Connecticut resident, please use the "Inquire by Email" button. Andover Ansonia Ashford Avon Barkhamsted Beacon Falls Berlin Bethany Bethel Bethlehem Bloomfield Bolton Bozrah Branford Bridgeport Bridgewater Bristol Brookfield Brooklyn Burlington Canaan Canterbury Canton Chaplin Cheshire Chester Clinton Colchester Colebrook Columbia Cornwall Coventry Cromwell Danbury Darien Deep River Derby Durham East Granby East Haddam East Hampton East Hartford East Haven East Lyme East Windsor Eastford Easton Ellington Enfield Essex Fairfield Farmington Franklin Glastonbury Goshen Granby Greenwich Griswold Groton Guilford Haddam Hamden Hampton Hartford Hartland Harwinton Hebron Kent Killingly Killingworth Lebanon Ledyard Lisbon Litchfield Lyme Madison Manchester Mansfield Marlborough Meriden Middlebury Middlefield Middletown Milford Monroe Montville Morris Naugatuck New Britain New Canaan New Fairfield New Hartford New Haven New London New Milford Newington Newtown Norfolk North Branford North Canaan North Haven North Stonington Norwalk Norwich Old Lyme Old Saybrook Orange Oxford Plainfield Plainville Plymouth Pomfret Portland Preston Prospect Putnam Redding Ridgefield Rocky Hill Roxbury Salem Salisbury Scotland Seymour Sharon Shelton Sherman Simsbury Somers South Windsor Southbury Southington Sprague Stafford Stamford Sterling Stonington Stratford Suffield Thomaston Thompson Tolland Torrington Trumbull Union Vernon Voluntown Wallingford Warren Washington Waterbury Waterford Watertown West Hartford West Haven Westbrook Weston Westport Wethersfield Willington Wilton Winchester Windham Windsor Windsor Locks Wolcott Woodbridge Woodbury Woodstock Zip Code * Phone * (###) ### #### How did you hear about this class? * Court Brochure Online Search Family or Friend Lawyer or Mediator The fee for the class is $150. How will you be paying for the class? * I will bring $150 in cash or money order to the class. I will send a $150 check one week prior to my class. I will bring a signed copy of my court fee waiver form to the class. Is there anyone who you do NOT want to attend the same class as you? * You have the right to attend the class together or separate from any individual. I do not want a specific person attending the same class as me. I have no preferences who attends the same class as me. If you do not want a specific person attending the class with you, include his/her name. Have there been any safety concerns or domestic violence issues between you and your child(ren)'s other parent? * Yes, there have been safety concerns or domestic violence issues. No, there have not been safety concerns or domestic violence issues. If YES, please explain. 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. If YES, provide the type of order and the first AND last name of all individuals in the order. Would you like to bring an adult guest with you to class? * You are welcome to bring an adult guest (over 21 years of age) with you to the class, free of charge. Your guest may NOT be another adult who is ordered to take the class NOR can it be one of your own children. Yes No If YES, please provide your guest's name. Do you have any special needs to assist you in attending the class? * Yes No If YES, please describe your needs and how we can best meet them. 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. If the organization is able to accommodate my request, I will receive an email confirming that I am registered for the desired class. If the requested class is not available, I will be provided with alternative classes by phone or email. I agree
Middletown/GD Saturday, January 20, 2018 9:00 AM 4:00 PM Gilead Community Services 230 Main Street Extension Middletown, CT, 06457 United States (map) Google Calendar ICS Parent Education Program Class Description: No additional details. Call with Questions Inquire by Email Register Online PEP Registration Name * First Name Last Name Email Address * Street Address * Apartment or Unit # City/Town * If you are not a Connecticut resident, please use the "Inquire by Email" button. Andover Ansonia Ashford Avon Barkhamsted Beacon Falls Berlin Bethany Bethel Bethlehem Bloomfield Bolton Bozrah Branford Bridgeport Bridgewater Bristol Brookfield Brooklyn Burlington Canaan Canterbury Canton Chaplin Cheshire Chester Clinton Colchester Colebrook Columbia Cornwall Coventry Cromwell Danbury Darien Deep River Derby Durham East Granby East Haddam East Hampton East Hartford East Haven East Lyme East Windsor Eastford Easton Ellington Enfield Essex Fairfield Farmington Franklin Glastonbury Goshen Granby Greenwich Griswold Groton Guilford Haddam Hamden Hampton Hartford Hartland Harwinton Hebron Kent Killingly Killingworth Lebanon Ledyard Lisbon Litchfield Lyme Madison Manchester Mansfield Marlborough Meriden Middlebury Middlefield Middletown Milford Monroe Montville Morris Naugatuck New Britain New Canaan New Fairfield New Hartford New Haven New London New Milford Newington Newtown Norfolk North Branford North Canaan North Haven North Stonington Norwalk Norwich Old Lyme Old Saybrook Orange Oxford Plainfield Plainville Plymouth Pomfret Portland Preston Prospect Putnam Redding Ridgefield Rocky Hill Roxbury Salem Salisbury Scotland Seymour Sharon Shelton Sherman Simsbury Somers South Windsor Southbury Southington Sprague Stafford Stamford Sterling Stonington Stratford Suffield Thomaston Thompson Tolland Torrington Trumbull Union Vernon Voluntown Wallingford Warren Washington Waterbury Waterford Watertown West Hartford West Haven Westbrook Weston Westport Wethersfield Willington Wilton Winchester Windham Windsor Windsor Locks Wolcott Woodbridge Woodbury Woodstock Zip Code * Phone * (###) ### #### How did you hear about this class? * Court Brochure Online Search Family or Friend Lawyer or Mediator The fee for the class is $150. How will you be paying for the class? * I will bring $150 in cash or money order to the class. I will send a $150 check one week prior to my class. I will bring a signed copy of my court fee waiver form to the class. Is there anyone who you do NOT want to attend the same class as you? * You have the right to attend the class together or separate from any individual. I do not want a specific person attending the same class as me. I have no preferences who attends the same class as me. If you do not want a specific person attending the class with you, include his/her name. Have there been any safety concerns or domestic violence issues between you and your child(ren)'s other parent? * Yes, there have been safety concerns or domestic violence issues. No, there have not been safety concerns or domestic violence issues. If YES, please explain. 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. If YES, provide the type of order and the first AND last name of all individuals in the order. Would you like to bring an adult guest with you to class? * You are welcome to bring an adult guest (over 21 years of age) with you to the class, free of charge. Your guest may NOT be another adult who is ordered to take the class NOR can it be one of your own children. Yes No If YES, please provide your guest's name. Do you have any special needs to assist you in attending the class? * Yes No If YES, please describe your needs and how we can best meet them. 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. If the organization is able to accommodate my request, I will receive an email confirming that I am registered for the desired class. If the requested class is not available, I will be provided with alternative classes by phone or email. I agree
