<p class="cf-meta-value"><strong>Name</strong><br>Uilton Dias</p><p class="cf-meta-value"><strong>Email Address</strong><br>ufcbjj11@gmail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>2035220113</p><p class="cf-meta-value"><strong>Street Address</strong><br>240 Main Street</p><p class="cf-meta-value"><strong>City</strong><br>Ansonia</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06401</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>03/23/1974</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>16 & 12</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Uilton Dias</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>Paula Dias</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>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>Edgar Ferreras</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>2035508979</p>