meet our staff
Divorce Education & Co-Parenting Pre-Enrollment Form
Work Phone (Include Work Extension)
Name of Other Parent
Primary Phone Number for Other Parent
Please list the names and ages of all children you have with the OTHER PARENT only (To add more than one child, please click the "+" sign to the right of the "age" column)
Child 1 Name
Child 1 Age
Were you asked (or ordered) by a court to contact us?
Name of Judge
Which court? (city)
Next Court Date
Please enter the name and phone number for YOUR ATTORNEY
Please enter the name and phone number for the OTHER PARENT'S ATTORNEY
Do you and/or your co-parent have current restraining orders?
Please read the following carefully. When you are done, please click the submit button. You will need to sign your name and indicate the date on an actual form prior to class. I understand that I will be enrolled in one or more divorce education classes. I understand that divorce education is not counseling or psychotherapy. I will pay for my enrollment in divorce education in advance. I will pay for my enrollment with cash, a valid credit card, or a money order. No checks are accepted for payment. If I am scheduled to attend a class and do call within 24 hours of my appointment to cancel or reschedule, I will pay an additional 'no show' fee of $30 as a condition of attending divorce education. I understand that the instructor in my class may be a licensed mental health professional. If so, I understand that, as required by California law, a licensed mental health professional must make an official report to appropriate law enforcement agencies if he or she suspects anyone poses a a threat to harm oneself or others, has abused a child, or poses a risk to do so. Except for reasons such as this, I am entitled to confidentiality. If, however, the court has ordered the staff of Solutions For Families to communicate to it (the court) about my participation in any phase of divorce education and/or mediation, I understand that the court order overrides my right to confidentiality. Further, I understand that any fees I pay for any divorce education and/or mediation service offered by Solutions for Families does not obligate the staff of Solutions for Families without compensation to write a report, testify in court, or participate in settlement proceedings. If I have been ordered by the court to attend Solutions for Families Part B (Co-parenting), or consent on my own to do so, I understand that the staff of Solutions for Families may need to share very limited information with others (such as my co-parent, my child's attorney). Such information would be limited, unless I agree otherwise, to the following: (a) whether I have attended Part A, (b) whether I have expressed a willingness to take Part B (Coparenting), (c) whether I am scheduled to take Part B, or (d) whether, after taking Part A, I decline to take Part B. Any such information will be shared with others only if doing so is necessary on the part of the staff of Solutions for Families to schedule Part B (Co-parenting).
Click this box to indicate that you have read and agree to the above terms and conditions
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