Please make a selection.(Required) I will print my workbook before the first Class Please mail my workbook to the address provided above
The program Workbook is 45 pages. Do you prefer we mail it or do you prefer to print the workbook?
Ethnicity(Required) **Please select from the menu below** African American Asian Hispanic Native American White Bicultural Other Prefer not to disclose
(for statistical purposes only)
Year of Birth(Required) **Please select from the menu below** 1995 - 2005 1980 - 1994 1965 - 1979 1944 - 1964 Born in 1943 or before Prefer not to disclose
(for statistical purposes only)
Program Participation Consent I hereby consent for myself to participate in the Cooperative Co-Parenting Class at Kids' Turn San Diego. The purpose of the Cooperative Co-Parenting Program is to increase awareness and practice of positive co-parenting approaches through a small group setting that allows for the time and space for parents to learn co-parenting skills and strategies to reduce co-parenting conflict and to learn about emotional triggers and ways to avoid them for parents who experience family separation and divorce. Co-parents do NOT attend at the same time. By providing co-parent information, you authorize Kids' Turn San Diego staff to ensure that your co-parent is not in the same Class. I agree and give my consent to participate in the three session, 7.5-hour Cooperative Co-Parenting Program. I understand that, within the bounds set by law, information, communications, observations and opinions derived from this program is considered confidential and that Kids' Turn San Diego Staff are mandated reporters of child abuse, elder abuse and child exposure to domestic violence. I understand that after successful completion of the program, I will receive a certificate of completion. I also understand that the program may be described in written publications, but that no information will be provided that could identify any individual participants in the program without their written consent. I agree that neither myself nor anyone representing me shall call on any staff persons involved in this program during or after my participation in the Kids' Turn San Diego Cooperative Co-Parenting program to provide either written or oral testimony at a deposition or in court on any issue related to my family. Neither I nor my representatives will subpoena any records from Kids' Turn San Diego for any purpose. I waive any right that I may have to call such person or subpoena such records in this or any action that is or may be filed. Further, all documents produced in the class become the property of Kids’ Turn San Diego. I give my consent for Kids’ Turn San Diego to use artwork, images or quotations made by me in brochures, literature or other public relations activities, but understand that I will not be identified by name. I understand that the facility used for the class is in no way responsible or liable for any action associated with the Cooperative Co-Parenting program. I understand that the registration payments are non-refundable, but in an extenuating circumstance, I may have my payment transferred for participation in a future class. I have signed below indicating that I have read, understand and agree to the above information.
