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. REGISTRATIONS CANNOT BE MADE ON A CELL PHONE OR OTHER DEVICES, ONLY HERE ON THIS WEBSITE.


PLEASE KNOW THAT YOU AND YOUR SPOUSE CANNOT BE ENROLLED IN THE SAME CLASS AT THE SAME PLACE/TIMES.

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
*Evening Phone
Attorney or Mediator
*Full Name of other parent (not your name)
Do you want to receive information on public events (classes, seminars, etc)?
Yes
No
Do you have a Court Waiver?
Yes
No
*Email