<p class="cf-meta-value"><strong>Name</strong><br>Maximilian </p><p class="cf-meta-value"><strong>Email Address</strong><br>Mmenillo01@yahoo.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>2035409882</p><p class="cf-meta-value"><strong>Street Address</strong><br>18 high street unit 1</p><p class="cf-meta-value"><strong>City</strong><br>Derby</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06418</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>05311990</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>5</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Milford superior court</p><p class="cf-meta-value"><strong>Do you have a fee waiver?</strong><br>Yes</p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Anna Lewis </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>Samantha </p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>2033437394</p>