<p class="cf-meta-value"><strong>Name</strong><br>Brian</p><p class="cf-meta-value"><strong>Email Address</strong><br>brianmathews@gmail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>6784290170</p><p class="cf-meta-value"><strong>Street address</strong><br>1212 love street</p><p class="cf-meta-value"><strong>City</strong><br>pittsburgh</p><p class="cf-meta-value"><strong>State</strong><br>pa</p><p class="cf-meta-value"><strong>Zip</strong><br>15812</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>12/05/1974</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>13</p><p class="cf-meta-value"><strong>Court District Your Case Is In</strong><br>West Hartford</p><p class="cf-meta-value"><strong>Do you have a fee waiver?</strong><br>Yes</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Leslie </p><p class="cf-meta-value"><strong>Do you wish to participate in the program with the other parent?</strong><br>No</p><p class="cf-meta-value"><strong>Is there any history of violence or abuse within the family?</strong><br>No</p><p class="cf-meta-value"><strong>Does the participant speak English?</strong><br>Yes</p><p class="cf-meta-value"><strong>Is the participant hearing impaired?</strong><br>No</p><p class="cf-meta-value"><strong>Emergency Contact Name</strong><br>leslie</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>6789836338</p>