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Fine Option Program Registration Form
Applicant Contact Info
Name
*
First
Last
Email
*
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Primary Phone
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Alternate Phone
Date of Birth
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Date Format: DD slash MM slash YYYY
Address
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Street Address
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Postal Code
Upload Gov't Issued Photo ID
*
Accepted forms of ID include documents such as your Driver's License or Passport.
Accepted file types:
JPG/JPEG, PNG, PDF
Max file size:
6 MB (6000 kb)
Drop files here or
Accepted file types: png, jpg, jpeg, pdf.
Court Info
Home Court Address
Street Address
City
State / Province / Region
Court Location
*
Court Date
*
Date Format: DD slash MM slash YYYY
Please enter the date when you appeared in court. Entries with dates in the future will be rejected as invalid.
Applicant Details
Provision of the information requested in this form is voluntary on your part and does not in any way determine your eligibility for any program. The information will be kept confidential and solely for planning and statistical purposes.
Gender
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Male
Female
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Other
Gender Identity
Ethnicity
Metis
Status Native
Non-Status Native
Caucasian
Employment Status
Employed
Unemployed
Student
Homemaker
Disabled
Which city would you like to volunteer in?
*
Select...
Regina
Saskatoon
Moose Jaw
Organizations of Interest (Saskatoon)
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
25th Street Theatre
Beaver Creek Bible Camp
Broadway Theatre
CHEP Good Food Inc.
Child Find Saskatchewan
Confederation Park Community Association
Dumont Technical Institute
EGADZ Youth Centre
Elizabeth Fry Society of Saskatchewan
Emmanuel Baptist Church
Fairfield Senior Citizens Corporation
Fairfield Senior Citizens Corporation
Friendship Inn
John Arcand Fiddlefest
La Troupe du Jour
Mission Thrift Store
New Hope Dog Rescue
Ness Creek Cultural & Recreational Society
Nutana Collegiate
OUT Saskatoon
Paved Art & New Media
Persons Living With AIDS Network of Sask
Salvation Army Community Centre
Salvation Army Thrift Store
Sanctum Care Group
Sask Community Youth Arts Program (SCYAP)
Saskatchewan Craft Council
Saskatchewan Environmental Society
Saskatoon Folkfest
Saskatoon Food Bank & Learning Centre
Saskatoon Indian & Metis Friendship Centre
Sask Institute on Community Living
Sask Native Theatre Company
Sherbrooke Community Centre
The Bridge Saskatoon
The Lighthouse Supported Living Inc
The Princess Shop
Treaty 6 Justice Collective
St. Patrick Parish
Turning Pages Youth Care Home
Village Green Furniture & Appliances
Westside Community Centre
Whitecap Dakota First Nation
Youth For Christ
YWCA Opportunity Shop
Organizations of Interest (Regina)
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
Ahmadiyya Muslim Jamma’at Mosque
Al Ritchie Community Association
All Nations Hope Network
Ehrlo Sports Venture
Habitat for Humanity Restore
Indigenous Christian Fellowship
Rainbow Youth Centre
Regina Muslim Peace & Cooperation Association
Regina Sikh Temple
Righteousness of Christ (ROC) Church
The Compass Church
The Gathering Place
Organizations of Interest (Moose Jaw)
Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here
to learn more about our partners.
Canadian Mental Health Association
Habitat for Humanity Moose Jaw
Hunger in Moose Jaw
Joe's Place
John Howard Society (Moose Jaw Branch)
Lyle Helland Memorial Field
Moose Jaw & District Senior Citizens Association
Moose Jaw Pride
Riverside Mission
Salvation Army Moose Jaw
Victory Church of Moose Jaw
Notice of Fine
*Do not list Federal surcharges -
NOT ELIGIBLE FOR FINE OPTION
Upload Notice
*
Upload the Notice of Fine and Surcharge or Conviction Letter that you received from court.
Accepted File Types:
jpg/jpeg, pdf
Max files:
5
Drop files here or
Accepted file types: jpg, jpeg, pdf.
List Infractions
*
Click the (+) to add a new fine.
File/Ticket No.
Act/CCC
Section
Fine $
Surcharge $
List Default Days (if any)
Click the (+) to add a new day.
File/Ticket No.
No. of Days
Date
Total Fines/PVF Surcharges
Total Hours
Billing Information
Total Amount of Fines
Hours of Work Completed
*
Minimum Wage
Work Service
Hours Completed x Minimum Wage =
Cash Paid
Balance Owing
Total Fines - Work Service - Cash Paid =
Completion Status
*
Complete
Incomplete
Special Interim Statement
Reason for incomplete billing info:
*
No Show
Chose to Pay Fine
Transferred
Terminated
Special Interim Report
Reason Not Known
Transferred to/from:
*
Reason for Termination:
*
Consent
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I understand and agree to the
privacy policy
.
Comments
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