Kids First Parent Network Organization

(KFPNO)

Membership application

First name*

Last name*

Date of birth*

Month

Day

Year

Mailing Address*

Email*

Phone*

Family situation:

• Are you currently going through a

Divorce / Legal separation

Custody Dispute

Guardianship

Domestic Violence Restraining Order

Blended family

Other

Briefly describe your current family situation and the challenges you are facing:

Write description below:*

Family information:

Relationship to Child(ren):*

How many children are involved?*

1 - 2 child(ren)

3 - 5 children

6 + children

What is the gender of the child(ren)*

Boy(s)

Girl(s)

Both

Below tell us the age of each child and provide a brief description of the relationship you have had with each child, since their birth.*

Co-Parenting Commitment:

• Are you willing to co-parent your child(ren) with the other parent?*

Yes

Briefly describe the current co-parenting relationship*

• Are you committed to setting aside personal opinions and feelings to prioritize the best interests of your child(ren)?*

Yes

Support Needs:*

• Please provide additional details about the support you are requesting:

Additional Information:

• Is there any other information you would like us to consider when reviewing your application?

Declaration:

I certify that the information provided in this application is true and correct to the best of my knowledge.

Signature

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Kids First, Parent Network Organization

951-824-7600

kidsfirstpn@gmail.com

PO Box 742 Riverside CA 92502

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