Parents Apart Registration Form

Please fill out the following form to register for Parents Apart. Please note that you must make payment before your registration is accepted.

If you are paying for a Court Waiver, a replacement certificate, or a missed class, please use the Online Shop for payment.

All starred (*) fields are required information.

*Name:
*Address:
*Daytime Phone:
Attorney or Mediator:
*Full Name of other parent (not your name):
*Email:
Do you have a Court Waiver?:
Yes
No
*Evening Phone:
Do you want to receive information on public events (classes, workshops, etc)?:
Yes
No
*Class Date and city it's in: