Parents, Children, and Divorce Registration Form

You can register several ways:

Print this form out from your browser window. Fill in the form by hand. Mail the completed form with payment method to:
Attn: Dee Comella, McHenry County College at University Center, 100 S. Main St., Crystal Lake, IL 60014.
In person, bring your completed form to the Registration/Cashier's Office in Room A258 at McHenry County College main campus (8900 US Hwy 14, Crystal Lake) where you may pay with cash, check or credit card.
Phone registration with credit card can be taken at (815) 479-7591.

CASE NUMBER_________________ Birthdate_______________

Name_________________________________________________________________________

Spouse's Name / other Parent's

Name_________________________________________________________________________

Address_______________________________ City_________________ State_____

Zip________

Phone: Daytime______________________________ Evening__________________________

Ages of each child______________________

Order of Protection ________Yes ________No / Restraining Order________Yes ________No

Court Appointed Guardian N/A______

Name__________________________________________

Preferred class day:
_____	Tuesdays 7 p.m. - 9 p.m.
_____	Saturdays 9 a.m. - 11 a.m.
_____	Tuesday 7 p.m. - 9 p.m. and Saturday 9 a.m. - 11 a.m. (when available)

$60.00 Class Fee Payment Method:
Credit Card:	_____Visa	_____MasterCard	_____Discover
Card Number:	____________________________	Expiration Date: _____
Card Number:	____________________________	VID:__________ (last three digits of number on back of card)
Cardholder Name:	____________________________	Amount: ________
Check:	Number_____

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2/1/08