Driver Intervention Program
2016-2017 SCHEDULE AND REQUIREMENT LETTER FOR DRIVER INTERVENTION PROGRAM (DIP)
  
 
PICKAWAY COUNTY                                         
Quality INN                                                          April 20th – 23th, 2017                                
24517 U.S. Route 23 (South)                             July 27th -30th, 2017
CIRCLEVILLE, OHIO 43113                                October 12th-15th, 2017
                                                                              
                                                                               
  

Registration will be at 5:00 PM for males and 5:30 for females. The fee for the program is $400, $200 of which is nonrefundable unless attendance is canceled (10) ten days prior to the program. Payment is due NO LATER THAN TEN (10) DAYS before the date of the program. Your space in the program IS NOT GUARANTEED UNTIL THE FEE IS PAID IN FULL.  All payments are either cash or money order and must be mailed to or paid at 101 ½ West Main St, Circleville. We are unable to accept a personal check. SPACE IS LIMITED. PAYMENT GUARANTEES YOUR PLACE IN THE SCHOOL. FIRST PAID/FIRST SERVED. YOU WILL BE PLACED ON A WAITING LIST IF THE SCHOOL FILLS BEFORE YOUR REGISTRATION IS FINALIZED BY PAYMENT.
READ PLEASE  THE FOLLOWING VERY CAREFULLY!!!
1. Participants are to be drug and alcohol free when arriving for the program. If you are suspected of using alcohol or other drugs, you will be asked to leave, your referral source will be notified and your fees will be forfeited. Upon arrival, you and your belongings will be searched to ensure a drug-free weekend.
2. Bring clothes (Group Appropriate) and any alcohol-free grooming articles necessary for three days.
3. Valuables and cash are brought at your own risk.

4. No phone calls will be allowed. You will not be able to make or receive calls. If there is an emergency, you will be contacted and arrangements will be made. Please take care of all personal and business matters prior to attending the program since no telephones will be made available. Please do not bring cell phones with you.
5. All medications need to be in ORIGINAL CONTAINERS and given to the DIP staff on the day you arrive.
BRING ONLY THE AMOUNT OF MEDICATION YOU WILL NEED FOR THE WEEKEND.
6. You must have approval from your referring court to reschedule. Contact your probation officer.
7. You will need to eat dinner before arriving for the program on Thursday night. All other meals will be provided for you.
8. If you have a food allergy or requirement you must notify the staff (10) ten days prior to the program.
9. You may bring snack foods in sealed original packages only. Do not bring open drinks or food, you will have to discard them.
10. Soft drinks and water will be available for $.50. Candy and snacks for $1.00
11. E-cigs or vapes are not permitted.
12. No aerosols allowed.
13. No playing cards.

14. No electronic devices are allowed.
15.. Upon your arrival, come to the conference room at the motel.

Register for Driver Intervention or Education Class

Name (First and Last)
Address
Blood Alcohol Content (B.A.C)
D.O.B
ALT Phone
Home Phone
Emergency Contact Phone
Age
Sex
Referring Court
Judge
Offense
Arrest Date
Do you have prior alcohol/drug treat? If so, when and where?
List all medications
Emergency Contact Name
Emergency Contact Address
Emergency Contact Relationship
Do you need to attend the 8hr or 72hr class?
Attending Date
Your Email Address
Submit

Payment must be made at local office to save a place in the program. Call 740-420-9490 for additional questions.