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Register yourself as a Divorced Dad
1. Personal & Business Information
1. Personal & Business Information
Name
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Username
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Contact Info
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Address
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E-mail
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Password
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Repeat Password
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2. Family Information
2. Family Information
Do you have children?
*
yes
no
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If yes, how many children?
*
1
2
3 or more
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What is the custody arrangement?
*
Sole Custody
Joint Custody
Visitation Rights
Others
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3. Areas Where You Need Support
Areas Where You Need Support
Select the Type of Services You Provide (Check All That Apply)
Legal Services (eg; Family Lawyer or Mediator)
Counseling/Therapy
Financial Planning/Advising
Coparenting Coaching
Parenting Class
Tax Advisory
Career Counseling/Life Coaching
Other
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4. Additional Information
4. Additional Information
What challenges are you currently facing?
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Do you have any specific goals you'd like to achieve through this platform?
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Preferred method of communication?
*
Email
Phone
Text Message
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5. Consent and Submission
5. Consent and Submission
1. Consent for Communication:
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I agree to receive communication from this platform, including emails, text messages, or calls, regarding available resources and professional connections.
2. Privacy Agreement:
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By submitting this form, I acknowledge that the information provided will be used solely for the purpose of connecting me with relevant professionals and resources.
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