Drug and Alcohol Diversion Class Registration

Each Diversion class is available only once to each teen. If you have previously taken the Drug and Alcohol Diversion Class, please consult with your referral source to consider other options. Please confirm that you have not taken the Drug and Alcohol Diversion Class previously. *

I have not taken the Drug and Alcohol Diversion Class previously.

Which of the following sessions would you like to sign up for? *

Monday, August 12th, 4:00-8:00pm Monday, September 9th, 4:00-800pm Monday, October 14th, 4:00-8:00pm Monday, November 11th, 4:00-8:00pm Monday, December 9th, 4:00-8:00pm

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Phone Number *

Area Code Phone Number

E-mail *

Date of Birth *

Age *

Note: If class participant is 18 - 20 years old a parent or guardian is not required to attend the class with them.

A parent or guardian is required to attend this class if class participant is under 18. Please provide the following information for the parent/guardian attending. *

Parent/Guardian Name(s)

Parent/Guardian E-mail

Parent/Guardian Phone Number

Reason for taking this class? *

Citation or other Court Order Internal Referral External Referral Personal Interest

If attending because of a citation, please provide your court file number, which can be found on the paperwork sent to you (Example 27-JV-00-0000). Please note - if you cannot find your court file number please call the juvenile court system to get the number so completion of the course can be reported. Please plan to bring the number to the class if you do not have it during time of registration.

Court File Number

If you filled in your court file number above, please ignore the following question. If you cannot find your court file number, but are attending the Diversion class because you received a citation or other court order, please check the box below agreeing to bring all of your citation paperwork/paperwork from the county to the class. The educator will work with you on a plan to ensure the county knows you completed the course.

I filled in my court file number above. I will remember to bring my citation paperwork to class.