Professional Provider Supervised Visitation Monitor Training Registration

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3878 Old Town Ave #200, San Diego CA 92110
Contact us for more information at (619) 683-9340 ext 33013 or training@sandiegopops.org

Name *

Phone Number *

Email Address *

Are you 21 years of age or older? *

Yes

Do you have a current or have you had a past court order in which you have been/are the person being supervised? *

Yes

Have you had a record of a conviction for child molestation, child abuse, or other crimes against a person? *

Yes

Have you had any civil, criminal, or juvenile restraining orders within the last 10 years? *

Yes

Have you have been on probation or parole during the past 10 years? *

Yes

Do you have a record or conviction of driving under the influence (DUI) within the last 5 years? *

Yes

Do you have proof of automobile insurance (for transporting child/ren)? *

Yes

I understand that I will have to pay $250 before or upon arrival of first day of training. *

Yes

Required

How will you pay your registration fee? *

Cash

check (payable to Paternal Opportunities Programs and Services)

Do you have Trustline/Live Scan? *

Yes

In progress

Are you a community partner? *

Yes

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