Enrol

Fields marked with * are required

Name & Surname *

ID Number *

Residential Address *

Cellphone Number *

Email Address *

Work Address

Relation To Children? *

Details of children: Names and Surnames, and Date of Birth *

Residential Address of Children *

Please indicate the current status of your relationship *

If married, are you still living together?

If not married, how long have you been separated?

If divorced, how long have you been divorced?

If living together but never been married (Section 21), are you still living together?

If Other: Please indicate the details

Do you have any court orders

Yes No

Briefly explain the disagreement(s)/ concerns between you and the other participant(s):

List your solutions to be discussed in mediation:

Do you have a current parenting plan?

List the current contact arrangements between the holders and the children: