Child Impact Registration Page

PLEASE NOTE that all Child Impact Program classes will be held via live video conference only, and will require participants to access Zoom via a device with audio and video capability. Please indicate which Child Impact Program class you are registering for:

Saturday, 20 April 2024, 9am - 1pm
Saturday, 18 May 2024, 9am - 1pm
Saturday, 1 June 2024, 9am - 1pm
Saturday, 15 June 2024, 9am - 1pm
Saturday, 6 July 2024, 9am - 1pm
Saturday, 20 July 2024, 9am - 1pm
Saturday, 3 August 2024, 9am - 1pm
Saturday, 17 August 2024, 9am - 1pm
Saturday, 7 September 2024, 9am - 1pm
Saturday, 21 September 2024, 9am - 1pm
Saturday, 5 October 2024, 9am - 1pm
Saturday, 19 October 2024, 9am - 1pm
Saturday, 2 November 2024, 9am - 1pm
Saturday, 16 November 2024, 9am - 1pm
Saturday, 7 December 2024, 9am - 1pm
Saturday, 21 December 2024, 9am - 1pm

If the class you are registering for is full, we will contact you. May we automatically register you for the next available class that has a seat open?

Yes
No

Attendee Name

First Name Middle Name or Initial Last Name

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone

Work Phone

Date of Birth

Court Docket or Case Number (if filed):

Court Name/Location

Name of Co-Parent

First Last

Is there a history of domestic violence or abuse in this relationship, or a restraining order filed in this case? (If yes, co-parents are not permitted to attend the same CIP class.)

Yes
No

Are you comfortable attending the CIP class with co-parent? (Note: co-parent attendance in the same class is at the discretion of the program provider.)

Yes
No

Do you need a foreign language interpreter?

Yes
No

Do you need a sign language interpreter?

Yes
No

Are you seeking a CIP class fee reduction to $50 on the basis of need? You will be required to submit a photocopy of your NH EBT (Food Stamps Program) and/or Medicaid card to qualify.

Yes
No

Are you seeking to have the CIP class fee waived entirely on the basis of need (low/no income)? You will be required to submit a State of NH Financial Affidavit (see link below).

Yes
No

CLICK HERE to open the official State of NH Financial Affidavit form in a new browser tab

If you need to submit an electronic copy of your State of NH Financial Affidavit, or a scanned photocopy of your NH EBT or Medicaid card (or any other pertinent documentation) with your CIP class registration, click on the 'Select Files' button below, then navigate to your file(s) and attach here.

Drop files here or

Max. file size: 2 MB.

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Child Impact Program Class Registration