Juvenile Underage Drinking Offenders Class (JUDO)

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Please fill in the form completely to register for the JUDO Online Class.

Court Appearance Date

MM/DD/YYYY

County/Referral Agency *

School District Name

If referred by a school, name of staff member who referred you?

First Name *

Middle Initial

Last Name *

Date of Birth *

MM/DD/YYYY

Age as of Today's Date

Street Address *

House number and street name

City *

State *

Zip Code *

Cell Phone

Home Phone

Email *

Where the JUDO online course information should be sent to

Other Address (Street, City, State, Zip)

If participant resides for all or part of the year at an address different from above (i.e. to attend college)

Are you 18 or older? *

Yes

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