PEP Test Below is the form that would replace the current registration form. Payment appears after the form is completed. PEP Event Registration PhoneThis field is for validation purposes and should be left unchanged.Which ClassImportant: Your registration for this class is not complete until the payment portion has been completed. After you register, you will receive an email from Kay Starks to complete your registration for the P.E.P. class you selected. If you have a fee waiver as payment, please email Kay for the waiver code. Kay.Starks@Klingberg.org (860) 832-5756 Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) How did you hear about us?Court BrochureOnline SearchFamily or FriendLawyer or MediatorYou have the right to attend the class together or separate from any individual. Is there anyone who you do NOT want to attend the same class as you?(Required) Yes, I do not want a specific person attending the class with me. No, I have no preferences who attends the same class. Have there been any safety concerns or domestic violence issues between you and your child(ren)’s other parent?(Required) Yes, there are there have been safety concerns or domestic violence issues. No, there have not been safety concerns or domestic violence issues Are there currently any active restraining orders, protective orders or no contact orders for either parent?(Required) Yes, there are restraining/protective/no-contact orders No, there are not any restraining/protective/no-contact orders Do you need a class taught in Spanish? / ¿Le llamaremos para registrarle?(Required) No Si (Yes) Do you have any special needs to assist you in attending the class?(Required) Yes, I have special needs for attending the class No, I do not have any special needs for attending the class By checking this box, you agree that you have read and understand the statement below.(Required)I understand that filling out this form does not guarantee me a spot in any specific Parent Education Class. A confirmation email will be sent to you regarding this form and payment. If the requested class is not available, you will be provided with alternative classes. Cost is $150 and payment is due in advance. We accept credit/debit cards. I Agree that I have read and understand.