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REGISTRATION FORM For Fee Reduction/Waiver ONLY for Level One Courses

A sliding scale fee is offered if adjusted gross income on the 1040 Income Tax Return is under $55,000 or if court fees have been waived by the Court. To qualify, please call us at 815-877-7228.

We will call you upon receipt of the registration.

LEVEL ONE (ONLINE) Parenting From Two Homes (meets mandatory requirement)
LEVEL ONE (ONLINE) Crianza Desde Dos Hogares (meets mandatory requirement)

Case Number: In County:

You are the: Marriage Date:

Attorney: yes no Name:

Contact Information

Name: Birth Date:

Address:

City: State: ZIP Code:

Email Address:

Phone:

Name of other parent:

Number of children involved:

First Child

Name:

Sex: Date of birth:

Second Child

Name:

Sex: Date of birth:

Third Child

Name:

Sex: Date of birth:

Fourth Child

Name:

Sex: Date of birth:

Fifth Child

Name:

Sex: Date of birth: