1 test pg parents apart oc Parents Apart Registration Orange CountyFirst Name of Program Participant *Last Name of Program Participant *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail *E news sign up By checking the box below, I agree to subscribe to DRC e-news which will be sent to email provided. I understand that I may unsubscribe at any time. DRC does not exchange, rent or sell its mailing list to any outside organization.Yes! I want to receive DRC e-news!Daytime Phone *Evening Phone/Cell *Name of Co-Parent *Required: registration cannot be confirmed if the co-parent name is left blank.Child's name/age/gender Child's name/age/gender Child's name/age/gender Child's name/age/gender Children live primarily with: Court information: Family File #/Next Court Date (skip if not applicable) Judge's Name or other Referral Source: Parents Apart Program Fee is $80.00 as of April 1st.Select first choice All classes are held 6:00 p.m. to 9:00 p.m.June 8th and 15th, 2020July 20th and 27th, 2020September 14th and 21st, 2020October 19th and 26th, 2020November 30th, 2020 and December 7th, 2020Select second choice All classes are held 6:00 p.m. to 9:00 p.m.June 8th and 15th, 2020July 20th and 27th, 2020September 14th and 21st, 2020October 19th and 26th, 2020November 30th, 2020 and December 7th, 2020TERMS OF REGISTRATION *(A) an email will be sent to address provided with registration confirmation and instructions for attending class; (B) no reminders provided prior to class start date; (C) notification required 48 hrs prior to date of first class if unable to attend; (D) $15 rescheduling fee will apply for each date change; (E) failure to attend scheduled class forfeits any money paid.I have read, understand and agree to above terms by typing my name in signature box below. I certify that the credit card used for payment is in my name as Program Participant and I authorize payment to DRC as submitted through PayPal for this class. *Signature - type name in box Follow instructions below and submit VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
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