WP E-Signature by Approve Me - Sign Documents Using WordPress -

6. Contract for Co-Parenting Counseling and Skill Building Sessions

I am requesting services from Co-Parenting Solutions, LLC in order to resolve issues related to the custody and care of our children in an effort to work out the terms and conditions under which I shall Co-Parent, and/or to receive strategies and develop skills that will enhance our Co-Parenting style. I acknowledge and agree to the following conditions:

I agree that while everything said during an individual session is confidential between myself and Ms. Wolfson and protected by the standard Notice of Privacy, any discussion during a joint session can be forwarded to both parties in a general summary if requested by one party. Release of information to any other professionals or agencies beyond the two Co-Parents must be authorized in writing by both parents so as not to violate the confidential nature of our work together unless services Court Ordered (see contract for Court Ordered cases). In that case, information can be released to the Judge or professionals from the Friend of the Court.
I understand that I am encouraged to make a sincere effort toward focusing on the Co-Parenting process in sessions without intention of using discussion during these sessions in any pending or subsequent litigation.
I understand that Ms. Wolfson is a neutral party and her role is to educate parents and advocate for the needs of our children in this process.
I understand that recording devices shall not be used under any circumstances during a session due to the confidential nature of sessions.
I understand that individual Co-Parenting Skill Building and Counseling Services has a fee of $180 per session and payment is required at the time of the session. Other fees may be charged in addition to the sessions at a rate of $180/hour including:
- Consultation by employees of Co-Parenting Solutions with other professionals
- Email communication (unless it is just for scheduling appointments)
- Telephone conversations in excess of five minutes
- Travel time and expenses, if relevant

Each parent will be solely responsible for 50% of the fees for shared sessions and will not be responsible for the other person’s half.

Policy on Missed Sessions:
I agree to pay the per session fee for any session booked, unless the session is cancelled at least twenty-four hours in advance. If I do not attend a session booked, I will pay the full session fee within three days of the session, after which I agree that I will be charged interest, and any costs of collection.

By signing below, I acknowledge that I have read and understand the conditions of the Co-Parenting counseling contract, and have had my questions answered before signing.

Date Signed:

Revised 12/2019

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

July 24, 2020 2:53 pm EDT

6. Contract for Co-Parenting Counseling and Skill Building Sessions Uploaded by Jordana Wolfson - jordana@coparentingsolutionsllc.com IP 68.60.107.55

August 18, 2020 10:07 am EDT

Document owner michael@yourppl.com has handed over this document to jordana@coparentingsolutionsllc.com 2020-08-18 10:07:47 - 75.128.132.184