Request edit access
Fill in this Registration Form & SUBMIT. You are then registered in the class you requested if fees have been paid on-line. If we have any questions about your registration, we will contact you. Not hearing from us still requires you to attend/show-up to your first day of class or call 48 hrs in advance to cancel/reschedule. Note: without a proper cancellation, there will be no refunds.
First and last name
Date of Birth
SS# or Drivers Licence/ID No.
Select Program & Location
DWI Education (3100 E. 4TH Street, Fort Worth, TX)
DWI Education (5601 Bridge Street, Suite 300)
Assessment/Evaluation (will be contacted by Clinician for appointment & location)
Did you make an on-line payment (If so, please bring your receipt to 1st day of class or appointment)
Class Start Date:
Name of Probation/Parole Officer/Case Worker, etc.
Probation/Parole/Case Worker Location
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