PEP Registration with Yardley Associates

Each parent must register separately. Please only complete the registration form for yourself.

Due to COVID-19, all classes for PEP (Parent Education Program) are now offered ONLINE.

Email *
First Name *
Last Name *
Address *
Town/City *
State *
Zip *
Phone Number
How did you hear about our classes? *
If you heard about us from a lawyer, mediator, or service provider, please tell us their name.
Please select one of the following Parent Education Programs that you want to attend. *
The fee for the class is $150. How will you be paying for the class? *
If you are paying by Venmo, what is your Venmo username for us to send you a Venmo request?
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.
Have there been any safety concerns or domestic violence issues between you and your child's other parent? *
If yes, please explain.
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.
You are welcome to have an adult guest (over 21 years old) attend the online class with you 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. *
If yes, please include your guest's first name and last name below. If your guest will be joining the online class separately from you, please include their name AND email address.
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