Parent Education Registration Form

Children need extra support and attention during difficult times. Our Parent Education Program will provide the skills to lessen the impact of family changes.

After completing the following form CCRS staff will contact you to confirm your registration and request payment information. This option is only available for those using Visa or MasterCard. Registration is not guaranteed until credit card payment is received.

Parent Education Program Registration Form

required = required field

1. Personal Information

requiredLegal First Name:

requiredFull Middle Name:

requiredLast Name:

requiredDate of Birth:  mm/dd/yyyy

requiredAddress :

requiredCity:

requiredState:
  

requiredZip:  97045 / 97045-1234

requiredPrimary Phone:  ###-###-####

requiredPhone Type:
Home   
Cell   
Work   
Other

Secondary Phone:  ###-###-####

Phone Type:
Home   
Cell   
Work   
Other

E-mail:

requiredPlease keep my contact information confidential from the other party.
    Yes No

Have you participated in any other Clackamas County Resolution Services?
    Yes No


2. Class Day and Date Preference

requiredPrimary choice:

requiredSecondary choice:

Please note: When selecting a class date, please be aware that our classes often book up several weeks in advance. The fact that a class date shows up in the drop down menu does not mean that it is still available.


3. Court Case Information

Case Number:

Filing Type:

Filing Date:  mm/dd/yyyy

Filed in:

If your filing did or will occur in other than Clackamas County, you will need to check with the other county's judge to see if this class meets their requirements. Once your registration fee is paid, it is non-refundable.

I am the:

requiredOther Party's Legal First Name:

requiredOther Party's Full Middle Name:

requiredOther Party's Last Name:

4. Safety Information

Family Court Services will register parties to the same court case in different classes if either party answers “yes” to any of the questions listed below.

requiredThere has been a Restraining Order in effect between the other party and me in the last year.
Yes
No

requiredThere has been domestic violence between the other party and me in the last year.
Yes
No

requiredThere is a No Contact Order (in a criminal case).
Yes
No

requiredI would prefer to attend a separate class from the other party.
Yes
No


5. Accomodations Information

Do you require interpretation services?
Yes
No

If Yes, Language:

Do you require any other accommodations?  
Yes
No

What accommodations do you need?