Co-Parenting Class – June 10, 2023

Name *

Email *

Phone *

Address *

City/Town *

State/County *

Zip/Post Code *

Country * none selected Afghanistan Albania Algeria American Samoa Andorra Angola Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Côte D'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Costa Rica Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar(Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Réunion Sào Tomé And Príncipe Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu US Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wales Yemen Zambia Zimbabwe

Were you ordered by a court to take this class? * Yes
No

If agency or court ordered, which agency?

How old is the child/ren involved? *

How would you describe your relationship/communication with the other parent? * Select ... Great Good Fair Bad Hostile

Are there any special circumstances that should be known (required accommodations, extreme relationship issues, trouble reading/writing)

If it important that the other parent not attend the same class as you, please include his/her name. (Please note that registration is on a first come-first serve basis)

Rules All Participants Must Agree to Follow

This class is approved through the Supreme Court of VA and is monitored for adherence to the rules below.

• Must know how to participate in a Zoom call.
• Must have a stable internet connection and devise to use for participation.
• Must log in by 8:55 a.m. If you try to enter the class past 9:15 am, you will not be admitted to the class and will have to reschedule.
• Must attend and participate in class for all 4 hours (You will get a couple of breaks during the class.)
• Must log in using your first and last name.
• Must make yourself visible through video for the entire 4-hour class.
• Must be an active participant by asking questions and answering questions.
• Must be respectful of all other participants in the class.
• Must be dressed appropriately for class and in an appropriate area of your home.
• Area you are in should be free of distractions such background noise, children playing, dogs barking, etc. for your benefit and other participants as well. You will need to have childcare available so you can devote your undivided attention to the class.
• Please have your class book, pen, and paper available to use for taking notes during the class.
• Upon completion of the class, you will need to complete the evaluation to receive your Certificate of Completion.

I understand each of these rules and agree to comply with these guidelines.

* I agree
I DO NOT Agree


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