Child Impact Form

Child Impact Form

Please review before registering:

  1. Co-parents may not attend the same Child Impact Program class and must register separately.
  2. Payment must be made at time of registration. The court ordered fee of $85.00 must be paid prior to being assigned to a class. Individuals receiving some form of public assistance may be eligible for a reduced rate. Please complete financial aid form if you wish to apply for a fee waiver or reduction.
  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 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.
  5. There is a $25 rescheduling fee for missed classes. If you miss your scheduled CIP class and wish to reschedule, we must receive the $25 fee payment prior to rescheduling. To pay the rescheduling fee, please complete the form below and enter $25.00 into the ‘price’ field.

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.

*Monday classes are being held at 2 Wall Street while Saturday classes are being held at 401 Cypress Street until further notice. For the Monday classes, one must attend BOTH consecutive Monday classes.

*PARTICIPANTS MUST ARRIVE 15 MINUTES PRIOR TO START OF CLASS. NO LATE ADMISSIONS WILL BE ALLOWED. LATE ARRIVALS WILL AUTOMATICALLY RESULT IN THE NEED TO RE-SCHEDULE THE CLASS.

  • For the Monday option, one must attend BOTH consecutive Monday classes
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