Please complete the following information. When information is received, a confirmation notice and Authorization for Confidential Information Sharing form will be mailed to you. However, be advised that payment as well as completion of the Authorization for Confidential Information Sharing form must be received by the Columbia County Connects office before you are considered registered for the class.

Date of Registration:
Court Appearance Date:
County in which you received your citation OR if no citation was issued, the name of the agency that referred you (i.e. Human Services, Teen Court, etc.):
Class Date:
First Choice:
Second Choice:
Student Name:
Date of Birth
Mailing Address:
City
State
Zip
Home Phone:
Cell Phone
Email:
If student is under 18 or living at home, the following information is needed:
Parent/Guardian Name:
Address (if different):
City
State
Zip
Day Phone:
Cell Phone:
Only check and Money Orders will be accepted for payment. Make checks payable to Columbia County Connects.