<p class="cf-meta-value"><strong>Telephone</strong><br>2032312408</p><p class="cf-meta-value"><strong>Street Address</strong><br>1000 knapps highway - unit 23</p><p class="cf-meta-value"><strong>City</strong><br>Fairfield</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06825</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>03-23-1976</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>10, 15, 17</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Bridgeport</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>Nicole brzoska</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>Robert Brzoska</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>203-846-0583</p>