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Register for a Parenting Education Program (PEP)
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SERVING INDIVIDUALS AND FAMILIES LIVING WITH MENTAL HEALTH NEEDS IN MIDDLESEX COUNTY SINCE 1968
Programs & Services
Parent Education Classes (PEP)
Register for a Parenting Education Program (PEP)
Parenting Education Program (PEP) Registration Form
Please fill out this form and we will email you to confirm your registration in the class, once payment and registration is complete.
Date & Time of Class Requested
(Required)
First Name
(Required)
Last Name
(Required)
Email
(Required)
Best Phone Number to contact you
(Required)
Street Address 1
(Required)
Street Address 2
Town or City
(Required)
State
(Required)
Zip Code
(Required)
How did you hear about us?
Court Brochure
Lawyer or Mediator
Family or Friend
Online Search
You have the right to attend the class together or separately from your child(ren's) other parent. Please check here if you DO NOT want to attend the same class.
(Required)
I DO NOT want to attend the same class as my child(ren's) other parent.
I have no preference
What is the other parent's full name?
(Required)
Have you and your child(ren's) other parent had any domestic violence issues or other safety concerns?
(Required)
Yes
No
Is there any type of Court Order currently filed against you or your child(ren's) other parent, such as a restraining order, protective order, or no contact order?
(Required)
Yes
No
Please provide the ages and genders of your children.
Why are you seeking Parenting Education Program (PEP) Classes?
Divorce
Separation
Custody Case
Other
Court Docket #
Do you have any special needs to assist you in attending the class?
(Required)
Yes, I may need assistance to attend the class
No, I do not need assistance to attend the class
If yes, please specify so we can make the appropriate accommodations
(Le llamaremos para registrarle) Do you need a class taught in Spanish?
(Required)
No
Si (Yes)
Did the Court provide you with a fee waiver for this class?
(Required)
No
Yes
If yes, you will be contacted to provide a copy of the court waiver.
By checking this box, you agree that you have read and understand the statement below.
(Required)
I agree that I have read and understand.
I understand that filling out this form does not guarantee me a spot in any specific Parent Education Class. An email will be sent confirming that payment and registration are complete prior to the day of your class. If the requested class is not available, you will be provided with alternative classes by phone or email. Cost is $150 and payment is due in advance. At this time, we only accept credit card payments. Thank you.
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