<p class="cf-meta-value"><strong>Telephone</strong><br>8608060413</p><p class="cf-meta-value"><strong>Street Address</strong><br>14 main street</p><p class="cf-meta-value"><strong>City</strong><br>Terryville </p><p class="cf-meta-value"><strong>State</strong><br>Ct</p><p class="cf-meta-value"><strong>Zip</strong><br>O6786</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>01/18/1997</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>3</p><p class="cf-meta-value"><strong>Name of Court</strong><br>New Britain </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>Sylvia </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>8608637248</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>8604592648</p>