<p class="cf-meta-value"><strong>Name</strong><br>Andrew Medeiros</p><p class="cf-meta-value"><strong>Email Address</strong><br>amedeiros3100@gmail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>5087172832</p><p class="cf-meta-value"><strong>Street address</strong><br>159 Hawthorne Drive Apartment 7C</p><p class="cf-meta-value"><strong>City</strong><br>New London</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06320</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>09/19/1990</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>Norwich </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>Kaitlin Allen</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>Desiree Edson</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>860-514-2009</p>