<p class="cf-meta-value"><strong>Telephone</strong><br>6154773370</p><p class="cf-meta-value"><strong>Street Address</strong><br>43 Hunter Lane</p><p class="cf-meta-value"><strong>City</strong><br>Fairfield</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06824</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>1/23/1979</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>4 and 7</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Bridgeport Courthouse</p><p class="cf-meta-value"><strong>Do you have a fee waiver?</strong><br>No</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Rich Terrell</p><p class="cf-meta-value"><strong>Do you wish to participate in the program with the other parent?</strong><br>No</p><p class="cf-meta-value"><strong>Does the participant speak English?</strong><br>Yes</p><p class="cf-meta-value"><strong>Is the participant hearing impaired?</strong><br>No</p><p class="cf-meta-value"><strong>Emergency Contact Name</strong><br>Rich Teitell</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>203-321-5748</p>