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2. Co-Parenting Class Via Zoom
   An internet connection, video camera, microphone and active participation is required to certify course completion.
4. I would like to register for the following class:*

   If the class is cancelled due to low registration numbers, or any other reason, you will be notified.

   1. Monday, September 19, 2022 ~ 4 pm to 7 pm ~ Online via Zoom video conference
   2. Tuesday, October 18, 2022 ~ 1 pm to 4 pm ~ Online via Zoom video conference
   3. Wednesday, November 30, 2022 ~ 9 am to Noon ~ Online via Zoom video conference
6. First Name*
7. Last Name*
9. Mailing Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Cell phone or Landline*

    1. Cell Phone
    2. Land Line
17. Email Address*
19. Name of Other Parent
    We request this information so we can let you know if the other parent registers for the same session. Instructor permission is required for both parents to enroll in the same session and priority is given to the registration received first. In the event the other parent registers, we will contact you to discuss this option.
21. First Name of Other Parent*
22. Last Name of Other Parent*
24. Are you attending to satisfy a court order or other requirement?*

    1. Yes
    2. No
25. If yes, please indicate the county your case is filed in or the agency involved.*

    1. Ashland
    2. Bayfield
    3. Other
26. If Other, please list.
28. Would you like to receive occasional emails regarding upcoming parenting classes offered by UW-Madison Division of Extension?*

    1. Yes
    2. No
30. UW Madison Division of Extension provides extra support on co-parenting through a free text message program. Participants receive 2-3 messages per week for 8 weeks that will reinforce class material and help you learn ways to support your child through separation and/or divorce. You can stop the messages at any time. Would you like to sign up for the Co-Parenting Text Message Program? Cell phone number must be provided above.*

    1. Yes
    2. No
32. Co-Parenting Fee
34. Co-Parenting Education
    Zoom Class
35. Price
36. Quantity*
37. Shipping Cost
39. Taxable
41. Continuing with your payment
    After Clicking "Proceed to Check Out", you will be directed to the Bayfield County E-Payment Center. If you have an account, you may either log-in OR Proceed as a guest (No Log-in) by clicking on the "Proceed to Check Out." You will continue to the next page.
43. You will LEAVE the Bayfield County website.

    You will leave the Bayfield County site and be redirected to a PayPal site to continue the checkout process. You will either login to your PayPal account or click on the gray button to pay with a debit or credit card. You will be on the PayPal site. You will be directed to enter your payment information. Thank You.

45. For more information or an alternate option to register, contact:

    Extension Bayfield County Educator Tracy Henegar at 715-395-1426 or tracy.henegar@wisc.edu. or Extension Ashland County Educator Heidi Ungrodt at 715-682-7017 or heidi.ungrodt@wisc.edu

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46. Calculate Totals Proceed to Checkout

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