Child Impact Form

Child Impact Form

Please review before registering:

  1. Co-parents may not attend the same Child Impact Program class.
  2. Payment must be made at the time of registration. If you are unable to pay the court-ordered fee of $85.00 please contact us at (603) 628-7787 to obtain a fee reduction/waiver application.
  3. You are required to provide your court docket number and court location during registration, and will not receive a certificate of completion after attending the seminar until both are provided.
  4. Registration is not complete until we have enrolled you in a class. A notification packet will be sent to you via US Postal Service Mail to confirm your assigned class date and time. You will not be permitted to attend a class for which you do not have a confirmation letter.

If paying by check, click here to print out form, complete and mail it with payment to Bedford Counseling Associates, 2 Wall Street, Suite 300 Manchester, NH 03101.

*Classes are held at 2 Wall St., Manchester and 121 Railroad St., Keene

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