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Confidentiality and Attendance Statement


I understand that:

     Once payment is made for the AEPM course, there are NO REFUNDS for ‘No Shows’ or for non-completion of both class days.

    NO REFUNDS will be given for students dismissed from class for violating class rules or disruptive behavior.  The instructor reserves the right to dismiss students for non-adherence of course rules.

    All registration forms must be completed and $60 payment made prior to attendance in class, either on-line or by Cashier’s Check or Money Order.

      Please make checks payable to Choosing to Change and mail to PO Box 2576 Porter, TX 77365 

    Classes must be taken in correct sequence.  Tardiness or absences from any class session will result in being dropped from the course and loss of registration fee.  Students would need to re-pay and take the entire course again.

    Students must complete a written exam with a minimum of 70% to receive a Certificate of Completion.

    Students must complete an individual exit interview for successful course completion.  Scheduled time is coordinated with the instructor and student after 6 hrs. of instruction.  Failure to attend at scheduled time will require a $10 re-scheduling fee.

    The student has the sole responsibility to notify the court of successful completion of the course by presenting my Certificate of Completion.  If the certificate is lost, there is a $10 fee for replacement.

    Students under the age of 16 must be accompanied by a parent or legal guardian at time of registration and have written permission of a parent of legal guardian to take the course.

    Special needs of a student must be made known to instructor 24 hrs. prior to a class.  (Call:  281-381-7812 for assistance.)

    Information about the student and progress in the alcohol awareness class may be used for research purposes.  I authorize such use with the understanding that this information will otherwise be held confidential and not released to other individuals or agencies for any reason without my signed consent or by the order of the court.  This consent may be revoked at any time.

           I agree to the Confidentiality and Attendance Statement.          

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