<p class="cf-meta-value"><strong>Telephone</strong><br>475-208-0303</p><p class="cf-meta-value"><strong>Street Address</strong><br>1157 Intervale Avenue apt 4G</p><p class="cf-meta-value"><strong>City</strong><br>Bronx</p><p class="cf-meta-value"><strong>Zip</strong><br>10459</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>08/26/1980</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>5</p><p class="cf-meta-value"><strong>Name of Court</strong><br>State of Connecticut Superior Court Stamford/Norwalk</p><p class="cf-meta-value"><strong>Do you have a fee waiver?</strong><br>Yes</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Jessica Sandoval</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>Robin Goode</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>914-661-0767</p>