<p class="cf-meta-value"><strong>Name</strong><br>John Burhans</p><p class="cf-meta-value"><strong>Email Address</strong><br>Jburhans83@gmail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>203-451-6304</p><p class="cf-meta-value"><strong>Street address</strong><br>150 Glover Ave apt 215</p><p class="cf-meta-value"><strong>City</strong><br>Norwalk </p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06850</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>12/08/1983</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>12</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Bridgeport Superior Court </p><p class="cf-meta-value"><strong>Other Parent Name</strong><br>Lesslie Burhans</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>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>Erica Burhans</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>203-570-5828</p>