<p class="cf-meta-value"><strong>Telephone</strong><br>5049312869</p><p class="cf-meta-value"><strong>Street Address</strong><br>96 Highway 607</p><p class="cf-meta-value"><strong>City</strong><br>Picayune</p><p class="cf-meta-value"><strong>State</strong><br>MS</p><p class="cf-meta-value"><strong>Zip</strong><br>39466</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>10/04/1990</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>13,12,9,6</p><p class="cf-meta-value"><strong>Name of Court</strong><br>State of Connecticut Judicial District </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>Jason Lott</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>Stacy Scott</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>504-473-8537</p>