The Mediation Center of the Coastal Empire

A 501c 3 Non-Profit Organization

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Homework – History with Co Parent & Childhood Experience

  • MM slash DD slash YYYY
  • Demographic Data

  • Please enter a number from 1 to 10.
  • Please enter a number from 0 to 100.
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  • Please enter a number from 0 to 10.
  • Please enter a number from 0 to 20.
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  • Therapy

  • Co-parent Data

  • List your three best qualities as a parent.

  • List your co-parent’s three best qualities.

  • List three areas you struggle with when parenting your child/ren.

  • List your three top concerns about your co-parent’s parenting abilities.

  • List your three main concerns about your children.

  • Please enter a number from 1 to 10.
  • What are the main issues, situations or events that cause conflict between you and your co-parent?

  • Please enter a number from 1 to 10.
  • List the top three ways you handle your stress levels on a daily basis.

  • List three ways you decompress after a disagreement/argument with your co-parent.

  • List your top three hobbies or outside interests and how often you partake in these activities. If none, insert none.

  • Childhood Experience

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The Mediation Center
5105 Paulsen Street, Suite 125D
Savannah, Georgia 31405
912-354-6686
info@mediationsavannah.com

Family Law Resource Center
912-354-6686
flrc@mediationsavannah.com

Youth Programs
912-999-2110
youth@mediationsavannah.com

Contact Us

The Mediation Center of the Coastal Empire
5105 Paulsen Street
Suite 125D
Savannah, GA 31405

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