<p class="cf-meta-value"><strong>Name</strong><br>Daniel Ross</p><p class="cf-meta-value"><strong>Email Address</strong><br>dross98765@aol.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>9172576399</p><p class="cf-meta-value"><strong>Street Address</strong><br>61 Pocconock Trail</p><p class="cf-meta-value"><strong>City</strong><br>New Canaan</p><p class="cf-meta-value"><strong>Zip</strong><br>06840</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>10/04/1968</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>17, 13</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Stamford Family Court</p><p class="cf-meta-value"><strong>Do you have a fee waiver?</strong><br>No</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Hua Chen</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>Phyllis Ross</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>860-434-2796</p>