Enroll Step 1 of 9 11% Your InformationName(Required) First Last Relationship to Child(Required)---MotherFatherLegal GuardianGrandparentOtherOther Relationship to Child(Required) Services Requested(Required) Family Steps Program Ongoing, Onsite Supervised Parenting Time Online Supervised Parenting Time Supervised Exchanges Which parent will be exercising their parenting time(Required) Mom Dad Both If Both, will you be exercising parenting time together?(Required) Yes No Email(Required) Phone(Required)Emergency ContactEmergency Contact - Name First Last Emergency Contact - Relationship to you Emergency Contact - PhoneEmergency Contact - Email Co-Parent InformationTheir Name(Required) First Last Their Email (if known) Their Phone Child(ren) InvolvedFirst Child - Name(Required) First Last First Child - Date of Birth(Required) MM slash DD slash YYYY First Child - Custody (Choose all that apply)(Required) Physical Legal Joint (50/50) Joint (other) Add a Second Child(Required) No Yes Second Child - Name First Last Second Child - Date of Birth MM slash DD slash YYYY Second Child - Custody (Choose all that apply) Physical Legal Joint (50/50) Joint (other) Add a Third Child No Yes Third Child - Name First Last Third Child - Date of Birth MM slash DD slash YYYY Third Child - Custody (Choose all that apply) Physical Legal Joint (50/50) Joint (other) Add a Fourth Child No Yes Fourth Child - Name First Last Fourth Child - Date of Birth MM slash DD slash YYYY Fourth Child - Custody (Choose all that apply) Physical Legal Joint (50/50) Joint (other) Is this a Child Protective Services (CPS) referral?(Required) Yes No Are you court ordered(Required) Yes No What is the Court File Number(s)?(Required) Order Types (Choose all that apply)(Required) Order For Protection (OFP) Harassment Order (HRO) Custody OFP: Date Ordered:(Required) MM slash DD slash YYYY HRO: Date Ordered:(Required) MM slash DD slash YYYY Custody: Date Ordered:(Required) MM slash DD slash YYYY OFP: Length of the Order(Required) HRO: Length of the Order(Required) Custody: Length of the Order(Required) OFP: Attach the Order(Required)Max. file size: 25 MB.Please include the page of your order that shows the Parenting Time stipulations.HRO: Attach the Order(Required)Max. file size: 25 MB.Please include the page of your order that shows the Parenting Time stipulations.Custody: Attach the Order(Required)Max. file size: 25 MB.Please include the page of your order that shows the Parenting Time stipulations.Referral Source:(Required) If applicable, who is YOUR:Attorney Social Worker Guardian Ad Litem Probation Officer After you press the SEND button below, you're enrollment forms will be submitted. Thank you.CommentsThis field is for validation purposes and should be left unchanged.
