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Child Impact Program Registration Form
If you need assistance in registering, please call 603-965-0601

Program Information

  • Currently, Child Impact classes are being held online via GotoMeeting
  • The Child Impact Program is a 4-hour requirement.
  • Offered on:
    • 2 consecutive Tuesday evenings in 2-hour sessions 6-8pm
    • Saturdays in one 4-hour session 9-1pm
  • Please refer to the schedule for Program dates and times on the Child Impact Registration Form
  • To receive a Certificate of Attendance you must complete the 4 hour requirement and provide your required court docket number.
  • Programs start promptly on scheduled time
  • Logins up to 15 minutes late may be accepted. Beyond 15 minutes will require rescheduling.
Registration Fee:
  • The fee for the Program is $85.00 per person
  • Please Note: The fee must be paid, via PayPal, by credit/debit card, or by check or Money Order when registering for the Program or you will not be placed in a class.
State Aid:
  • If you are receiving state aid (food stamps, APTD, TANF, or Medicaid/Medicare) then you may qualify for a reduced fee.
  • Please download and complete the PDF form CIP Request to Reduce or Waive Fee listed below.
  • Return to CLM with proof of state assistance for approval before you can register for the Child Impact Program.
  • Mail or deliver this form to Center for Life Management, 10 Tsienneto Road, Derry, NH 03038, Attn: Child Impact Coordinator.

Requesting a Reduced or Waived Fee:

  • If you are not receiving assistance, but are unable to pay, you may request a reduced or waived fee.
  • You must download and complete the CIP Request to Reduce or Waive Fee and the State of NH Financial Affidavit forms. The NH Financial Affidavit must be notarized by the court .
  • Return to CLM for approval before you can register for the Child Impact Program.
  • Mail or deliver this form to Center for Life Management, 10 Tsienneto Road, Derry, NH 03038, Attn: Child Impact Coordinator.

Click Here to view/download the PDF form for CIP Request to Reduce or Waive Fee

Click Here to view/download the PDF form for State of NH Financial Affidavit

PDF Files require the FREE Adobe Acrobat Reader... get it here...

Confirmation
  • Class placement is NOT guaranteed until payment is received.
  • We will try to honor your first choice date request.
  • A confirmation will be sent BY EMAIL after payment is received.
Rescheduling Fee
  • A Rescheduling fee of $25.00 will be charged for any cancellations received within 48 hours before the scheduled Program or for any missed sessions. The rescheduling fee must be paid before the rescheduled class.
Forfeiture of Registration Fee
  • Failure to complete the program within 6 months of registration will result in forfeiture of registration fee.
If you have questions about completing any of these forms, please call 603-965-0601