Grant County Fresh Start Program - Registration Form

Fill out COMPLETELY AND CLEARLY; unreadable or incomplete forms will be invalid, and your ticket will go to court.

 

Send with money order within 10 days of citation and send to Fresh Start, P.O Box 506, Lancaster, WI 53813

First and Last Name: ____________________________________________________________________________________

Address: ______________________________________________________________________________________________

City, State, Zip: _______________________________________________________________________________________

Phone # where you can be reached: ____________________________________ Citation #: ____________________________

Birth Date: _______________Citation Date: __________________Confirmation # (If Pay online)_______________

  Check box, if you need to attend a class outside of Grant County. If you checked this box, then you do not need to send in the money  order. You will receive a letter with the contact information and directions.

 _______________List county in which you wish to take program.

Grant County Fresh Start Program - GUILTY PLEA AGREEMENT

I hereby admit to the charge of consuming/possessing intoxicants. I agree to successfully complete the Fresh Start program by:

1. Attending all 12 hours of education.

2. Completing all assignments

3. Actively participating

4. Passing all tests with a 70% or better

5. If under 17, one parent must attend the 3rd night of class

6. Not re-offending within one year of completing the course or before turning 21 whichever occurs first

If proof of successful completion is provided, this matter will be dismissed after one year if there are no other underage drinking offenses or until turning 21, whichever occurs first. I understand that if I re-offend within a year both citations will go to court, I will be required to pay both fines, and I will lose my operating privileges for a length of time determined by the judge.

I, the defendant, hereby consent to the above order, and agree to cooperate/participate in the program. If under 17, the undersigned parent(s)/guardian(s))) hereby consents to entry of the above order and agrees to cooperate/participate in the program.

Date: _______________ Defendant Signature:

Date: _______________ Parent (s)/Guardian(s) Signature: