Yardley Associates, LLP Parent Education Program Online Registration
Please only register yourself. Each parent must register separately.
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Town/City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
How did you hear about our classes? *
If you heard about us from a lawyer or mediator, what is his/her full name ?
Your answer
What Parent Education Program Class would you like to attend? *
The fee for the class is $150. How will you be paying for the class? *
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? *
If yes, please type in their first name and last name.
Your answer
Have their been any safety concerns or domestic violence issues between you and your child(ren)'s other parent? *
If yes, please explain.
Your answer
Are there currently any active restraining orders, protective orders or no contact orders for either parent? *
If yes, please include the type of order and the full first and last name of all individuals on the order.
Your answer
You are welcome to bring an adult guest (over 21 years old) 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 children. Would you like to bring an adult guest with you to class? *
If yes, please include your guest's first name and last name.
Your answer
Do you have any special needs to assist you in attending the class? *
If yes, please describe how we can best meet your needs.
Your answer
Please answer below that you understand that filling out this form does not guarantee a spot in your selected class. If Yardley Associates, LLP is able to accommodate your request, you will receive a confirmation email that you are registered for your desired class. If your requested class is not available, we will offer you an alternative class via email or phone. *
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