<p class="cf-meta-value"><strong>Name</strong><br>Chad Pramuka </p><p class="cf-meta-value"><strong>Email Address</strong><br>cpramuka9@gmail.com</p><p class="cf-meta-value"><strong>Telephone</strong><br>8603018204</p><p class="cf-meta-value"><strong>Street address</strong><br>110 Bicknell Rd</p><p class="cf-meta-value"><strong>City</strong><br>Ashford</p><p class="cf-meta-value"><strong>State</strong><br>CT</p><p class="cf-meta-value"><strong>Zip</strong><br>06278</p><p class="cf-meta-value"><strong>Date of Birth</strong><br>08/18/1981</p><p class="cf-meta-value"><strong>Ages of Children Involved in Court Case</strong><br>10, 8 & 6</p><p class="cf-meta-value"><strong>Name of Court</strong><br>Rockville JD</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>Carrie Lagasse </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>Amelia Pramuka</p><p class="cf-meta-value"><strong>Emergency Contact Telephone</strong><br>860-301-8938</p>