Municipal Court - Life of Crime Registration

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Henderson Life of Crime

Registration Form

* = Required information

Program Date:*

Child's First Name:*
Child's Last Name:*
Child's Age:*
Parent/Guardian's Name:
Phone: *
Phone (Other):
Email:
Street Address:
City:
State:
Zip Code:

Language: (English/Spanish/Other)

School Name:
School ID:
Referring Agency
Court Ordered (Judge Name):
Other (Explain)


Failure to appear will result in the inability to re-register for up to 6 months.