COOPERATIVE PARENTING合作教育

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1、COOPERATIVEPARENTSERVICESName_______________________________________Date:___________________________Birthdate_________________Age___________PlaceofBirth________________Race__________HomeAddress__________________________________________________________________

2、_______________(street)(city/state)(zipcode)HomePhone______________CellPhone_________________Email______________________________________BestNumbertoreachyou:_______________YourEmployer__________________________________________BusinessAddress__________________

3、_____________________________________________________________(street)(city/state)(zipcode)Occupation_________________________BusinessPhone________________LevelofEducation:HighSchool___________Bachelors___________Masters___________Above___________MaritalStatus

4、__________________LengthofMarriage_________________LengthofSeparation____________DateofDivorce_________________NumberofMarriages________________NumberofDivorces____________CustodyArrangements:Sole__________Joint:Legal__________Physical__________Both__________

5、_Child(ren)’sPrimaryCaretaker___________________________________________________________________Child(ren)’sLivingSituation_____________________________________________________________________VisitationSchedule_________________________________________________

6、____________________________OtherAdultsLivingintheHome__________________________________________________________________Children/Stepchildren:NameAgeGrade/SchoolBirthdate_________________________________________________________________________________________

7、___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8、____________________Attorney_______________________________________BusinessPhone_________________________________BusinessAddress___________________________________________________________