Co-Parenting Class Pre-Screening Form
This form helps us determine if our 8-week co-parenting series is the right fit for your family. Please answer openly to ensure a safe and productive group environment.
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Email *
Parent 1 Full Name *
Parent 1 Email Address *
Parent 1 Phone Number *
Parent 2 Full Name *
Parent 2 Email Address *
Parent 2 Phone Number *
Are you and your co-parent navigating a divorce, separation, or complex co-parenting situation? *
Are you experiencing conflict or communication challenges with your co-parent? *
Are you committed to supporting your child’s emotional well-being and development? *
Are you and your co-parent open to attending class together in a neutral, structured space? *
Does either parent have a history of domestic violence or harm to others? *
Is either parent experiencing an untreated substance use disorder? *
Is either parent unwilling or unable to attend class with the co-parent? *
Do you anticipate any significant scheduling conflicts that would prevent consistent attendance on Mondays from 5:00 PM - 6:30 PM PST? *
Please indicate your availability for a 1-hour intake screening session prior to registration.  *
How did you hear about this class? *
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