<p class="cf-meta-value"><strong>Name</strong><br>Derek Dombkowski</p><p class="cf-meta-value"><strong>Email Address</strong><br>Mazdaspeed6@ymail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>8609640211</p><p class="cf-meta-value"><strong>Street address</strong><br>1 moosehorn hill rd</p><p class="cf-meta-value"><strong>City</strong><br>West Granby </p><p class="cf-meta-value"><strong>State</strong><br>Ct</p><p class="cf-meta-value"><strong>Zip</strong><br>06090</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>09201986</p><p class="cf-meta-value"><strong>Appointment Reminders</strong><br>Text</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>11,10,10</p><p class="cf-meta-value"><strong>Name of Court</strong><br>State of CT superior court</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Kristen Dombkowski</p><p class="cf-meta-value"><strong>Do you wish to participate in the program with the other parent?</strong><br>Yes</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>Edward dombkowski</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>8606934343</p>