<p class="cf-meta-value"><strong>Telephone</strong><br>860-374-6014</p><p class="cf-meta-value"><strong>Street address</strong><br>17 Teaneck Road Apt #3C</p><p class="cf-meta-value"><strong>City</strong><br>Ridgefield Park</p><p class="cf-meta-value"><strong>State</strong><br>NJ</p><p class="cf-meta-value"><strong>Zip</strong><br>07660</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>01/04/2004</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>13</p><p class="cf-meta-value"><strong>Name of Court</strong><br>supeiror court judicial district of windam</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>Melissa Kobe</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>genisya universes</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>860-374-6014</p>