STATE OF HAWAII FAMILY COURT SECOND CIRCUIT KIDS FIRST INFORMATION SHEET CASE NUMBER FC- : PLAINTIFF DEFENDANT NAME: NAME: MOTHER/FATHER(circle) MOTHER/FATHER(circle) MAILING ADDRESS: MAILING ADDRESS: TELEPHONE: TELEPHONE: DATE OF PROGRAM: WEDNESDAY, C-H-I-L-D-R-E-N INITIALS OF CHILDREN SEX AGE LIVING W/WHOM? 1. 2. 3. 4. 5. ACTIVE RESTRAINING ORDER BETWEEN PARTIES Yes No IF EITHER PARENT LIVES ON THE ISLAND OF OAHU, HAWAII OR KAUAI, THAT PARENT MAY ATTEND THAT ISLAND222S SEPARATION/DIVORCE EDUCATION PROGRAM. FOR FURTHER INSTRUCTIONS CALL OAHU KIDS FIRST PROGRAM - 954-8280, HILO - 896-6465, KONA - 987-1046, OR KAUAI - 482-2350. FOR STAFF USE ONLY ATTENDED (Y/N) NOTES VERIFICATION FATHER MOTHER CHILD 1 CHILD 2 CHILD 3 CHILD 4 CHILD 5 COMMENTS: In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the Family Court Administration Office at PHONE NO. (808)244-2700, FAX (808) 244-2704 or adarequest@courts.hawaii.gov at least ten (10) working days prior to your hearing or appointment date. American LegalNet, Inc. www.FormsWorkFlow.com