Get Aep Registration Form. Please Print. - Steps At Liberty Center - Libertycenterconnections

Filling out the AEP Registration Form is an essential step for participants in the Alcohol Education Program. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the AEP Registration Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your personal details. Enter your full name, gender, today's date, and current address, including city, state, and zip code. Additionally, provide your county of residence and ethnic background by selecting from the given options.
3. Indicate your age and date of birth, as well as your height and weight. Make sure to provide accurate information.
4. Fill in your contact numbers: home phone, work phone, and cell phone. Include your Social Security Number and details of an emergency contact person with their relationship to you.
5. Provide information regarding your court referral. Include the name of the court, your probation officer's name, their phone number, and the date and time of your arrest. Also, fill in the reason for the stop, original charges, sentencing date, BAC at arrest, court case number, and final charge.
6. Complete the health history section. Mention any physical disabilities, dietary restrictions, food allergies, vegetarian status, smoking habits, and serious health problems or current treatments.
7. Respond to the psychological health questions honestly. Indicate if you have been treated for emotional or mental issues, and whether you currently take medications for these problems.
8. Verify the accuracy of your emergency contact information for medical emergencies. Ensure that the details are current and correct.
9. Sign and date the form to affirm that all information provided is truthful and accurate.
10. Once the form is completed, save your changes. You can then download, print, or share the form as needed.

Complete your AEP Registration Form now to participate in the program.