Acceptance of ONLINE
Refund/Cancellation policy
LEGAL First Name:
LEGAL Middle Name:
LEGAL Last Name:
Home Address:
Home Phone:
Student's Cell Phone:
Student's Email:
Parent/Guardian's Names
(if under 18):
Mom's Cell Phone:
Mom's Email:
Dad's Cell Phone:
Dad's Email:
~ Student Information for Court Certificate Preparation ~
Birthdate mm/dd/yyyy:
Age Now:
Texas License #
If you do not yet have a Driver's License,
you must submit your Social Security Number here:  
Eye Color:
Hair Color:
School Attending:
Grade level:
Your Attorney:
Attorney Phone:
~ Ticket Information ~
Type of ticket issued to you:
Describe the incident for which you were
given a ticket, and the judgment you
were handed down in the court of law:
Court Name:
Judge Presiding:
Ticket issuance date:
~ Course Registration Information ~
Dates of Class:
Times of Class:
** I will make my course
registration deposit by:
By submitting this registration form, your spot in the class will be held, BUT your
class registration will not be
officially secured until a tuition payment has been
submitted to the school.  
No tuition shall be refunded if any of the 6 hour
course is missed.  

, all other required enrollment forms below MUST be presented to the
prior to first hour of the first course day, or you will not be registered to
begin class at the time you have selected and will be forced to re-enroll.
(You may email these to us at after saving your document with your name in the file name)

Your registration must be accompanied by a Copy of Driver's License or
Social Security Card
(A scanned copy emailed to us is acceptable)
Alcohol Awareness Education for Minors Registration
Type full initials of submitting individual