Course Registration Form
Please fill out your personal details and class requirements to complete registration.
Client Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cause Number
Referral Source
*
Probation Officer Name
Probation Officer Email
example@example.com
Class Required
*
Please Select
Anger Management 4 hr
Anger Management 6 hr
Anger Management 8 hr
Anger Management 18 hr.
Tarrant County Anger Management
DWI Education
DWI Intervention
Drug Offender Education
Batterers Intervention & Prevention
Drug Offender Education Program Dates
Please Select
April 13-17
May 4-8
June 1-5
July 6-10
August 17-21
September 14-18
October 5-9
November 2-6
December 7-11
DWI Education Dates
Please Select
April 7-9
April 21-23
May 12-14
May 19-21
June 9-11
June 23-25
July 14-16
July 21-23
August 11-13
August 25-27
September 8-10
September 22-24
October 13-15
October 27-29
November 10-12
November 17-19
December 8-10
December 15-17
Client Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client Email
*
example@example.com
Register
Should be Empty: