Catholic Charities, Diocese of Norwich Parenting Education Program
Rockville-Tolland Judicial District
Willimantic-Windham Judicial District
Middletown- Middlesex Judicial District
New London-New London Judicial District
Norwich-New London Judicial District Name:
Home Phone #
Cell Phone #
Work Phone #
Best Time Or Number To Call :
Which Court Are You Using? Ages Of Children: English
Primary Language: Yes No
Do You Have Any Safety Concerns?
How Can We Best Accommodate You?
Explain: (Limited to Four Lines )
Is There Any One You Would Not Like To Be In The Same Class With? Do You Have Any Special Need?
If Yes Is That The Other Parent?
What Are They:
(Limited to Four Lines )
Mail Your Registration Form along with a JD-FM-149 Form (Parent Ed. Cert. & Results), $125.00 Payment, or Fee Waiver (Original signed by the court) TO: Catholic Charities Diocese Of Norwich, 331 Main Street, Norwich, CT. 06360 Acceptable forms of payment: Cash if you come in to the Norwich Office (No Personal Checks) / Mail In a Money Order made out to Catholic Charities, Diocese Of Norwich We also accept Credit/Debit Visa, MasterCard, Discover WE MUST RECEIVE FORMS /PAYMENTS DATED A WEEK BEFORE THE CLASS. QUESTIONS: Please Call 860-889-8346 ext. 263
Do You Have A Waiver From The Court For Fees? Cash
Card # Rescheduled?
(Must Be Signed By Court Clerk)
Money Order Visa
Credit Card By Phone:
Credit Card Discover
Exp Date: Yes No
Original Date Catholic Charities, Diocese Of Norwich 2013
Authorization # Rescheduled Date