Parent Education Registration Form

Children need extra support and attention during difficult times. Our Parent Education Program will provide the skills to lessen the impact of family changes.

After completing the following form CCRS staff will contact you to confirm your registration and request payment information. This option is only available for those using Visa or MasterCard. Registration is not guaranteed until credit card payment is received. Other registration methods are available.

Parent Education Program Registration Form

* = required field
1. Personal Information
Legal First Name :*
Full Middle Name :*
Last Name :*
Date of Birth:* mm/dd/yyyy
Address :*
City :*
State :*    Zip :*
Primary Phone :* ()   xxx-xxxx
Phone Type :* Home    Cell    Work    Other
Secondary Phone: ()   xxx-xxxx
Phone Type: Home    Cell    Work    Other
E-mail:
Please keep my contact information confidential from the other party.*
    Yes No
Have you participated in any other Clackamas County Resolution Services?
    Yes No

2. Class Day and Date Preference
Primary choice :*
Secondary choice:*

Please note: When selecting a class date, please be aware that our classes often book up several weeks in advance. The fact that a class date shows up in the drop down menu does not mean that it is still available.

3. Court Case Information
Case Number:
Filing Type:
Filing Date: mm/dd/yyyy
Filed in:
If your filing did or will occur in other than Clackamas County, you will need to check with the other county's judge to see if this class meets their requirements. Once your registration fee is paid, it is non-refundable.
I am the:
Other Party's Legal First Name:*
Other Party's Full Middle Name:*
Other Party's Last Name:*

4. Safety Information
Family Court Services will register parties to the same court case in different classes if either party answers “yes” to any of the questions listed below.
Yes No There has been a Restraining Order in effect between the other party and me in the last year.*
Yes No There has been domestic violence between the other party and me in the last year. *
Yes No There is a No Contact Order (in a criminal case). *
Yes No I would prefer to attend a separate class from the other party.*

5. Accomodations Information
Yes No Do you require interpretation services?
If Yes, Language:   
Yes No Do you require any other accommodations?  
   
  • FAX
    Available 24 hours a day. Complete and print the Registration Form. Write your Visa or MasterCard number and expiration date on the form, and fax it to us at 503-650-5656. Registration is not complete until CCRS confirms your payment with you by phone or in person.
  • Mail
    Complete and print the Registration Form and mail it with your check or Visa/MC number and expiration date. CCRS will call you if there is a problem with the registration. Registration is not complete until CCRS confirms your payment with you by phone or in person.
  • Phone
    Call us during business hours. Please have your Visa or MasterCard credit card number ready. For faster service, complete and print the registration form ahead of time.
  • In Person
    You may register in person at our office during business hours. For faster service, complete and print the registration form ahead of time. Payment in person may be in cash, check, money order, or Visa/MC.