Co-Parenting High Conflict Sessions Registration

Amapola Ramirez M.S. MSW. Facilitator Providing Services Since 2008

If you have any questions about completing this form please email me at aparenting1@gmail.com

Each parent must register separately and is responsible for paying for their sessions. Appointments will be scheduled for both parents once they have completed the entire registration form and paid the required fees. Appointment details will be sent via email.

Abundance Guidance Center is not a non-profit agency but provides fee-based co-parenting sessions with a focus on high-conflict situations. The center operates based on the enrollment and participation of its clients. There are no free or low-fee options available.

Resources can be provided to those in need. However, Abundance Guidance Center does not attend court to testify for or against clients or external parties. The center only provides specific documentation, including a letter of enrollment, a brief progress letter, and a letter of completion. Abundance Guidance Center is not responsible for any decisions a parent makes during or after completing the sessions.

First Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

The email you provide will be the same email through which both you and the other parent will receive your appointment time and date together. The email you provide is for parents to communicate with the facilitator only. Parents should communicate with each other exclusively through the court-ordered communication platform.

Email Address *

Emergency Contact

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Telephone # *

Please disclose any relevant medical conditions or concerns to the facilitator prior to starting the sessions so that appropriate steps can be taken in the event of an emergency. Your health and safety are our priority.

Do you have any medical conditions we need to know about? *

Yes

If you think it's important for the facilitator to know and consent to inform please type below:

If you marked YES do you consent for the facilitator to contact 911? *Abundance Guidance Center is not liable for ambulance fees. *

Yes, please contact 911 if I need help. I understand and agree that I am liable for any medical fees

No, I do not consent

Children Information

First Name *

Last Name *

Age: *

First Name

Last Name

Age:

First Name

Last Name

Age:

First Name

Last Name

Age:

Other Parent Information & Court

Other Parents First Name *

Other Parents Last Name *

Do you and the other parent have to attend together or separate? * Please make sure to confirm with your attorney if you are not sure. *

Together

Seperate

What do you use to communicate? *

Talking Parents

Family Wizard

None

How many sessions do you have to complete? *

10 weeks

12 weeks

15 weeks

It's up to the facilitator

Are there an active restraining order? *If there is an active restraining order you will be seen separately. *

Yes

Minors Counsel Information:

Please provide your minor's counsel contact information. Please note that your assigned minor counsel may contact the facilitator for updates on your progress.

First Name of Minors Counsel

Last Name of Minors Counsel

Email of Minors Counsel:

Letter you will be provided after completing the sessions:

Letters:

Parents may request a progress letter at any time, which will be provided within 24-48 hours. Letters of completion are issued to both parents via email at the end of the program. There are two types of completion letters:

Successful Letter of Completion:
This letter is provided to parents who have demonstrated progress by applying the skills learned during the sessions.
Unsuccessful Letter of Completion:
This letter is for parents who were unable to demonstrate sufficient progress and may require additional sessions. The facilitator may recommend further co-parenting sessions in such cases.

Letters will be sent to the email address provided during registration. Parents are responsible for forwarding the letter to their attorneys, as Abundance Guidance Center does not provide additional copies. Please ensure you save the letter for your records.

Attendance Policy:

Parents who miss two scheduled appointments without notifying the facilitator will be automatically placed on a waiting list until the next available appointment. It is the responsibility of the parents to contact the facilitator to follow up and schedule their next session.

No-Show Policy:

If one parent attends the session and is ready to begin, while the other parent fails to notify the facilitator and the attending parent, the facilitator will provide the attending parent with a No no-show proof of Attendance via email.

Read and check off *

I have read and understood the information provided

Payments

Payment and Registration Information:

Registration Fee: $65.00 (non-refundable)
Session Fee per Parent (Weekly): $90.00

Payment Guidelines:

Parents who opt to pay weekly must pay the day before or in advance of their scheduled session to avoid cancellation.
Parents may also choose to pay the full amount for the entire program upfront.

After Successful Registration: Once both parents have completed their registration, they will receive an email with the following details:

Appointment Date & Time
Zoom Link
Instructions on Where to Make Weekly Payments
Zoom Policy Reminder

The facilitator will primarily communicate with parents via email for faster responses, as her busy schedule may make it difficult to return phone calls.

Read and Check off *

I have read and understood the information provided

Virtual Zoom Sessions:

Online Virtual Sessions via Zoom

Same Link: Use the same Zoom link for each weekly session.
Consistent Schedule: Sessions will occur on the same day and time each week.

Safety Guidelines:

No Driving During Sessions:
For your safety, do not drive while participating in the session.
Location:
It is recommended that you participate from home. If you must be in your car, you are required to provide your location and license plate number for safety purposes.
Quiet Environment:
Ensure that you are in a quiet and non-distracting environment. You should not be laying in bed or multitasking during the session.
No Car Passengers:
You are not allowed to be a passenger in a vehicle during the session. Sessions may be rescheduled if the facilitator determines the environment is not confidential.
No Children Present:
Children should not be nearby during the session to maintain confidentiality and focus.
Wi-Fi Issues:
If you experience connectivity problems, the session will be rescheduled.
Camera Requirement:
Parents must keep their camera on for the entire duration of the session.

I hereby consent to and acknowledge that I fully understand the contents of this form and agree to follow its terms and conditions. *

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Mandated Reporter

Mandated Reporter:

Abundance Guidance Center is legally required to report any instances of physical, emotional, or psychological abuse, or neglect involving minors and seniors. As part of our commitment to transparency and courtesy, the facilitator will inform the families if such a report is made.

Read and check off *

I have read and understood the information provided

The role of the co-parenting facilitator:

The Role of a Co-Parenting Facilitator

A co-parenting facilitator is a professional who assists separated or divorced parents in managing and improving their co-parenting relationship, especially in high-conflict situations. Their primary goal is to ensure the well-being of the children involved by promoting effective communication and collaboration between parents.

Key Responsibilities:

Mediation and Conflict Resolution:

Facilitate discussions to resolve disagreements regarding parenting plans, visitation schedules, and other child-related matters.Provide a neutral environment where both parents can express their concerns and work toward mutually acceptable solutions.

Enhancing Communication:

Teach effective communication skills to reduce misunderstandings and minimize conflict.Encourage respectful dialogue focused on the best interests of the children.

Developing Parenting Plans:

Assist parents in creating comprehensive parenting plans that outline custody arrangements already provided by the court (facilitator does not make any changes to the court order) decision-making responsibilities, and routines. Ensure that the plans are practical and serve the children's needs.

Providing Education and Resources:

Offer guidance on co-parenting strategies, child development, and the impact of parental conflict on children.Share resources such as reading materials, workshops, or referrals to other professionals like counselors or therapists.

Monitoring Progress:

Keep track of the parents' adherence to agreed-upon plans and the effectiveness of their communication.Provide feedback and adjust strategies as necessary to improve co-parenting dynamics.

Collaborating with Professionals:

Work with social workers, minor's counsel, and other relevant parties to coordinate care and support for the family.Share updates on attendance and participation when appropriate and with consent.

Maintaining Confidentiality and Professionalism:

Uphold ethical standards by protecting the privacy of all parties involved.Remain unbiased and focus on facilitating solutions rather than taking sides.

Importance of a Co-Parenting Facilitator:

Child-Centered Approach: Ensures that the children's emotional and developmental needs are prioritized.

Reduced Legal Interventions: Helps parents resolve issues amicably, potentially reducing the need for court involvement.

Stress Reduction: Alleviates tension by providing tools and strategies to manage conflicts effectively.

Improved Co-Parenting Relationship: Fosters a collaborative partnership that can adapt to the children's changing needs over time.

A Co- Parent facilitator (CPF) is a person who is appointed by the court to assist parents in split families in resolving parenting issues using procedures that are not confidential (no secret policy between parents and facilitator).

The Co Parenting Class Will Cover:
• Emotional effects of divorce.
• Emotional and behavioral reactions to divorce by children.
• Parenting issues relating to specific developmental stages.
• Stress indicators in children.
• Conflict Management.
• Family stabilization through Parenting relationship development.

Every case is different and since parents normally do not have a healthy co-parenting.

Conclusion:

A co-parenting facilitator plays a vital role in helping parents navigate the complexities of raising children after separation or divorce. By promoting effective communication and cooperation, they contribute to a healthier family dynamic that benefits both the parents and the children involved.

Read and check off *

I have read and understood the information provided

Consent for Services

Abundance Guidance Center – Consent for Services

I, hereby agree to participate in the services provided by Abundance Guidance Center. I understand and acknowledge the following:

Scope of Services:
I am voluntarily participating in co-parenting sessions offered by Abundance Guidance Center, which focuses on high-conflict situations. The center provides guidance, but it is not responsible for any personal decisions or actions I take during or after completing these sessions.

Fee Agreement:
I understand that Abundance Guidance Center is a fee-based organization, and no free or low-cost services are available. I agree to pay all required fees as outlined in the payment options provided to me.

Non-Profit Disclaimer:
I acknowledge that Abundance Guidance Center is not a non-profit organization. The center operates based on client participation and does not offer financial aid or low-cost options.

Confidentiality and Communication:
I understand that any communication outside of scheduled sessions, such as brief emails or progress letters, will be limited as per the center’s policies. I agree to communicate with the facilitators via email, as phone calls may take up to four days to be returned.

Court and Legal Disclaimers:
I acknowledge that Abundance Guidance Center does not testify in court or provide letters for legal purposes beyond the enrollment letter, a brief progress letter, and the letter of completion. These letters will only reflect my participation in the program.

Program Policies:
I have read and agree to adhere to all policies outlined by Abundance Guidance Center. I understand that new policies may be introduced at any time and that I will be informed if any changes affect my participation.

Cancellations and Rescheduling:
I understand my responsibility to notify the center in a timely manner if I need to cancel or reschedule a session. I am aware that missed sessions without notice may result in additional fees or penalties.

Responsibility and Behavior:
I agree to maintain a positive and open-minded attitude throughout the program and take responsibility for my own learning and development. I understand that any decisions I make during or after the sessions are solely my responsibility.

Safety and Rules:
I understand that rules may be added or modified at any time to ensure the safety and well-being of all participants in the program.

Refund Policy:
I acknowledge that the registration fee is non-refundable. If I pay for the full session package and decide to withdraw before starting, I may be eligible for a full refund. If I withdraw after attending some sessions, I will be refunded the remaining balance. I must contact the facilitator via email to request a refund.

New rules can be added at anytime

By signing below, I agree to the terms and conditions of this consent form. *

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Todays Date * +

Payment

If you pay for registration only or registration only for the first session, please know you must pay weekly one day before each session to avoid canceling your session. All weekly fees must be made one day before or days before to confirm your attendance.After both parents have successfully registered, both parents will receive an email with additional information on how to make their weekly payment, appointment time and day, & link.

No refunds after you have attended a session you already paid for.

Please Choose: Registration fee is NON-REFUNDABLE *

Only Registration ($65.00)

First Session & Registration ($90+ $65)

Registration & Full 10-week sessions ($65 +$900)

Registration & Full 12-week sessions ($65 +$1,080)

Current Total:

$0.00

Please ensure that your payment is successfully completed to avoid any delays in your registration process. You do not need a PayPal account to make the payment; it can be processed without one. Please confirm by checking your bank account to verify that the payment was made. Parents will not be given an appointment if both the registration form and payment are not fully completed.

Card number *

Expiration *

Name on card *