<p class="cf-meta-value"><strong>Telephone</strong><br>646-825-0577</p><p class="cf-meta-value"><strong>Street Address</strong><br>1233 South Pine Creek Road</p><p class="cf-meta-value"><strong>City</strong><br>Fairfield</p><p class="cf-meta-value"><strong>Zip</strong><br>06824</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>11/17/1983</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>5</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>Adrienne Cuff</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>Patricia Cuff</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>727-452-4671</p>