Special Needs Acknowledgment *

I confirm that none of the children included in this mediation session have significant special needs — such as autism, severe developmental disabilities, or other conditions that substantially impact their daily functioning or independence. If any child does, this session is not appropriate for your situation.

First Name *

Last Name *

Phone *

Email *

Spouse's First Name *

Spouse's Last Name *

Spouse's Phone *

Spouse's Email *

State You Reside In *

How Many Minor Children Do You Have Together? *

What Are the Ages of Your Children? *

Have You and Your Spouse Had Any Preliminary Discussions About a Plan? *

I have read and agree to the Terms and Conditions of the Parenting Plan Mediation Session

Signature *

Clear