<p class="cf-meta-value"><strong>Telephone</strong><br>920-627-0155</p><p class="cf-meta-value"><strong>Street Address</strong><br>48 Northridge Road</p><p class="cf-meta-value"><strong>City</strong><br>Old Greenwich</p><p class="cf-meta-value"><strong>Zip</strong><br>06870</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>11/05/1991</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>9, 8, 5</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Stamford</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>Emma</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>Is there any history of violence or abuse within the family?</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>Emma Paluchniak</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>630-207-2710</p>