High Conflict Diversion Program Class Form

Monday Classes - Online & In-person

Parents - please complete this intake form prior to taking the High Conflict Divorce Program parenting class. All fields are required.


Please indicate if you are interested attending classes online or in-person.
Please make sure you have correctly entered your first name.
Please make sure you have correctly entered your last name.
Please make sure you have correctly entered your email address.
Please make sure you have correctly entered your phone number and area code.
Please make sure you correctly enter your street address.
Please make sure you correctly enter your suite or unit number.
Please make sure you have correctly entered the name of your city.
Please make sure you have selected your state from the drop-down.
Please make sure you have correctly entered your zip code.
Please list the name of the other parent.
Please type the name of the judge assigned to your case.
Please enter the name of your attorney.
Please enter the name of the other parent's attorney.
Please select the radio button that corresponds to the number of children you have.
Please enter the name of your first child.
Please enter the age of the first child.
Please enter the name of your second child.
Please enter the age of the second child.
Please enter the name of your third child.
Please enter the age of the third child.
Please enter the name of your fourth child.
Please enter the age of the fourth child.
Please enter the name of your fifth child.
Please enter the age of the fifth child.
Please enter the name of your sixth child.
Please enter the age of the sixth child.
Please indicate how long you have been separated/ divorced.
Please use the text area to briefly describe the issues that are part of the conflict between you and the other parent.
Please select the number from the drop-down that indicates how many times have you been to Family Court Services or Family Court in the last 2 years.
Please indicate if an attorney is assigned to your child or children.
Please indicate if there been a psychological evaluation completed or ordered for you.
Please indicate if there been a psychological evaluation completed or ordered for your spouse.
Please indicate if this a divorce or paternity case.
Please indicate if you have a personal history or experience with high conflict divorce or custody.
Please describe your current child sharing arrangement or court order for child sharing.
Please let us know if there is anything else you would like us to know,
Please describe what you would like to learn from this program.
Recaptcha is blocking your submission.