<p class="cf-meta-value"><strong>Telephone</strong><br>2032435801</p><p class="cf-meta-value"><strong>Street Address</strong><br>6 Dorel terrace </p><p class="cf-meta-value"><strong>City</strong><br>Ansonia</p><p class="cf-meta-value"><strong>State</strong><br>Ct </p><p class="cf-meta-value"><strong>Zip</strong><br>06401</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>02/26/1976</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>13/16</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Milford Court</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>Clara Marowa</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>Clara</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>203-339-1058</p>