Pre-Registration Form for  Danger Without Intentions Programs  (If you want to pre-register, you can send it by email as noted below) 
    You can not fill out this form from this page, you will have to do the following in order to fill out this form:

    To send information by email, you will need to do the following:  
    1)  CLICK above on the tool bar:   File
   2)  Under FILE click on:                  SEND
    3)  Under SEND click on:                 Page by Email  
It will open up you email, FILL OUT the Pre-Registration Form and then just put in our email address into the TO field.    Our  email is:

Pre-Registration Form
for :

If you would like to Pre-Register by Email, we will need ALL of the following information filled in for getting registered to attend any of the 2 programs listed below:


Mark with "X" which Class you are  Pre-Registering for:


  Alive at 25 4th Edition (Alive25) $50 - 4 Hour Program


-  Choices & Consequences  (CAC)

$30 - 3 Hour Program


-  Drunk Driving / Victim's Impact Panel  (DD-VIP)

$30 - 3 Hour Program





Enter Date & Location you would like to attend:






All Field Must be filled in to get Registered:



Your Full Name



Your Birthday



Male / Female



What you got in trouble for



Is this your 1st time for this citation?



Case / Cause Number



Court System



Judge's Name



Phone # for Text Message Reminder



Contact Person if different that participant attending





        Additional information needed only for ALIVE at 25 Class  
      13  Color of your eyes  
       14 Male or Female  
       15 Drivers License Number  
       16 Full Mailing Address with City, State & Zip Code  

 Should you have any questions, please feel free to contact us via email, text message, or by calling either of our numbers listed below.


Deborah Parsons & Guy Benson

Danger Without Intentions
501(C)3 Non-Profit Educational Corporation
Drunk Driving / Victim's Impact Panel
Alcohol & Drug Awareness Programs
Alive @ 25 - Young Drivers Program
Choices and Consequences Program
Student Behavior & Truancy Awareness
Boating & Water Information Safety

Toll Free:      1-866-893-2821
Phone:              512-924-9637
Fax No:             830-839-4209