Attend Program

*Please note: You must register for a program that is already scheduled on the Program Calendar.

 
 

Personal Information:

Name (required)

Birthdate (required)

Email (required)

Home Phone

Cell Phone

Street Address

City

County

Zip Code

 
 

Case Information: (*Required for Hamilton County*)

Court Case Judge

Case Docket Number

County of Offense

 
 

VIP Program Information:

County Where You Would LIke To Attend Program

Program Date You Would LIke To Attend (View Program Schedule at Top of This Page)

 
Following your submission of this form, you will receive an email confirming that we have received your information. If you do not see this message in your inbox, remmber to check your spam folder.