BEGIN:VCALENDAR VERSION:2.0 PRODID:-//Giveing All Back - DIP - ECPv6.16.2//NONSGML v1.0//EN CALSCALE:GREGORIAN METHOD:PUBLISH X-WR-CALNAME:Giveing All Back - DIP X-ORIGINAL-URL:https://givingallbackdip.com X-WR-CALDESC:Events for Giveing All Back - DIP REFRESH-INTERVAL;VALUE=DURATION:PT1H X-Robots-Tag:noindex X-PUBLISHED-TTL:PT1H BEGIN:VTIMEZONE TZID:UTC BEGIN:STANDARD TZOFFSETFROM:+0000 TZOFFSETTO:+0000 TZNAME:UTC DTSTART:20250101T000000 END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20260729T170000 DTSTAMP:20260613T080259 CREATED:20260301T161853Z LAST-MODIFIED:20260611T170339Z UID:225-1776153600-1785344400@givingallbackdip.com SUMMARY:August 6 - 9 Registration Rossford Location 3 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n\n \n \n Intake forms - August 6 - 9 Registration Rossford Location 3 Days\n \n "*" indicates required fields \n \n CompanyThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/august-6-9-registration-rossford-location/ CATEGORIES:3 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20261021T170000 DTSTAMP:20260613T080259 CREATED:20260301T162213Z LAST-MODIFIED:20260611T170250Z UID:231-1776153600-1792602000@givingallbackdip.com SUMMARY:October 29 - November 1 Registration Rossford Location 3 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - October 29 - November 1 Registration Rossford Location 3 Days\n \n "*" indicates required fields \n \n EmailThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/october-29-november-1-registration-rossford-location-3-days/ CATEGORIES:3 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20261104T170000 DTSTAMP:20260613T080259 CREATED:20260301T162302Z LAST-MODIFIED:20260611T170240Z UID:233-1776153600-1793811600@givingallbackdip.com SUMMARY:November 12 - 18 Registration Rossford Location 6 Days DESCRIPTION:6 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - November 12 - 18 Registration Rossford Location 6 Days\n \n "*" indicates required fields \n \n X/TwitterThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/november-12-18-registration-rossford-location-6-days/ CATEGORIES:6 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20260916T170000 DTSTAMP:20260613T080259 CREATED:20260301T162718Z LAST-MODIFIED:20260611T170319Z UID:241-1776153600-1789578000@givingallbackdip.com SUMMARY:September 24 - 30 Registration Maumee Location 6 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - September 24 - 30 Registration Maumee Location 6 Days\n \n "*" indicates required fields \n \n CommentsThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/september-24-30-registration-maumee-location-6-days/ CATEGORIES:6 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20261007T170000 DTSTAMP:20260613T080259 CREATED:20260301T162848Z LAST-MODIFIED:20260611T170258Z UID:243-1776153600-1791392400@givingallbackdip.com SUMMARY:October 15 -21 Registration Maumee Location 6 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - October 15 -21 Registration Maumee Location 6 Days\n \n "*" indicates required fields \n \n EmailThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/october-15-21-registration-maumee-location-6-days/ CATEGORIES:6 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20261111T170000 DTSTAMP:20260613T080259 CREATED:20260301T162934Z LAST-MODIFIED:20260611T170230Z UID:245-1776153600-1794416400@givingallbackdip.com SUMMARY:November 19 - 22 Registration Maumee Location 3 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - November 19 - 22 Registration Maumee Location 3 Days\n \n "*" indicates required fields \n \n InstagramThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/november-19-22-registration-maumee-location-3-days/ CATEGORIES:3 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260414T080000 DTEND;TZID=UTC:20261125T170000 DTSTAMP:20260613T080259 CREATED:20260301T163017Z LAST-MODIFIED:20260611T170217Z UID:247-1776153600-1795626000@givingallbackdip.com SUMMARY:December 3 - 9 Registration Maumee Location 6 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People\n\n \n \n Intake forms - December 3 - 9 Registration Maumee Location 6 Days\n \n "*" indicates required fields \n \n InstagramThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n \n \n \n Other\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/december-3-9-registration-maumee-location-6-days/ CATEGORIES:6 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260625T080000 DTEND;TZID=UTC:20261023T170000 DTSTAMP:20260613T080259 CREATED:20260301T162500Z LAST-MODIFIED:20260611T170158Z UID:237-1782374400-1792774800@givingallbackdip.com SUMMARY:August 20 - 26 Registration Maumee Location 6 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - August 20 - 26 Registration Maumee Location 6 Days\n \n "*" indicates required fields \n \n FacebookThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP –Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/august-20-26-registration-maumee-location-6-days/ CATEGORIES:6 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20260808T080000 DTEND;TZID=UTC:20261206T170000 DTSTAMP:20260613T080259 CREATED:20260301T162553Z LAST-MODIFIED:20260611T170056Z UID:239-1786176000-1796576400@givingallbackdip.com SUMMARY:September 10 - 13 Registration Maumee Location 3 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - September 10 - 13 Registration Maumee Location 3 Days\n \n "*" indicates required fields \n \n NameThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/september-10-13-registration-maumee-location-3-days/ CATEGORIES:3 Day END:VEVENT BEGIN:VEVENT DTSTART;TZID=UTC:20261104T080000 DTEND;TZID=UTC:20270701T170000 DTSTAMP:20260613T080259 CREATED:20260314T162355Z LAST-MODIFIED:20260611T170042Z UID:235-1793779200-1814461200@givingallbackdip.com SUMMARY:December 17 - 20 Registration Rossford Location 3 Days DESCRIPTION:3 Day DIP Program\n* Maximum 25 People \n\n \n \n Intake forms - December 17 - 20 Registration Rossford Location 3 Days\n \n "*" indicates required fields \n \n X/TwitterThis field is for validation purposes and should be left unchanged.CLIENT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Email*\n \n Date Registered:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Program Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*SSN*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n Home Phone*Work Phone*Prescribed Medications:*All prescription medication is required to be surrendered in the original\, labeled\, containers which will be made available to you at the prescribed times. Any over-the-counter medication must be in a new\, unopened package (i.e. aspirin\, cold tablets\, vitamins). Non-Prescribed Medications:*Special Needs Diet:*Known allergies/Food reactions:*Primary Care Physician:*Pregnancy Status:*Smoker:*Prior Alcohol/Drug Treatment*When/Where*EMERGENCY CONTACT INFORMATIONName*\n \n \n \n First\n \n \n \n \n Last\n \n \n Phone*Address* \n \n \n \n Street Address\n \n \n Address Line 2\n \n \n City\n \n \n State / Province / Region\n \n \n ZIP / Postal Code\n \n \n LEGAL INFORMATIONOrdering Court:*Case Number*Breathalyzer Results:*Attorney:*Drivers License Number:*State:*CHECK ONE:*\n \n \n 2-Point Credit; You must have between 5-11 points on your record at time of course\n \n \n \n 12-Point Suspension; you must have received your notice from the state\n PAYMENT INFORMATION ALL FEES ARE NON-REFUNDABLEMy payment of:*\n \n $550 | 72 Hour DIP Shared Room\n \n \n $695 | 72 Hour DIP Private Room\n \n \n $940 | 6 Day DIP Shared Room\n \n \n $1220 | 6 Day DIP Private Room\n Paytrace*\n \n \n Card Number\n \n \n Month010203040506070809101112\n Expiration Month\n \n \n Year20262027202820292030203120322033203420352036203720382039204020412042204320442045\n Expiration Year\n \n \n \n Security Code\n \n \n Consent* I agree to the privacy policy.CANCELLATION POLICY\n\n\nA 48-hour cancellation notice is required to change registered dates of attendance. If you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired\, the registration fee will not be refunded and there will be a $100 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential.\n\nBy signing I also acknowledge and understand the above noted cancellation policy.Client Signature*\n \n \n \n First\n \n \n \n \n Last\n \n \n Cancellation PolicyA 48-hour cancellation notice is required to change registered dates of attendance or you fail to attend a scheduled weekend program\, or must change your scheduled weekend after the 48-hour time period has expired the registration fee will not be refunded and there will be a $50 rescheduling fee. We do understand that unusual circumstances arise which may have prohibited you from canceling your appointment or program with advance notice. Please discuss these situations with us and under certain circumstances\, we may determine to waive the rescheduling fee. Please note\, if you do need to reschedule\, this may be done ONE TIME ONLY.\n\nI give Giving All Back DIP permission to charge my credit card for the program and amount selected above. I understand that my payment information will be kept confidential. By signing I also acknowledge and understand the above noted cancellation policy.Consent* By checking this box\, you acknowledge that you have read\, understood\, and agreed to all information\, policies\, terms\, and conditions contained within this form\, and certify that all information submitted has been completed truthfully and to the best of your knowledge and ability.By typing your full legal name below and submitting this form\, you acknowledge and agree that your typed name constitutes your electronic signature and is legally binding to the fullest extent permitted by applicable law. You certify that you have read\, understood\, and agree to all policies\, terms\, conditions\, waivers\, and procedures associated with this registration and participation.\n\nYou further affirm that all information and documentation provided through this online form has been completed truthfully and to the best of your knowledge and ability. You understand and acknowledge that additional paperwork\, signatures\, acknowledgments\, or verification of information may be required in person on the day of class or participation\, and you agree to complete any such required documents at that time.Name as Signature*\n \n \n \n First\n \n \n \n \n Last URL:https://givingallbackdip.com/event/december-17-20-registration-rossford-location-3-days/ CATEGORIES:3 Day END:VEVENT END:VCALENDAR