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Court Ordered Community Service Application

Court Ordered Community Service Application (Must be over 16+ years old, a first time offender, and a Martin County resident)
First Name:
Last Name:
Age (16+ Only):
Date of Birth:
Address:
City:
State:
Zip:
Phone:
Email:
Emergency Contact Name:
Relationship:
Emergency Contact Phone:
Alternate Number:
THIS AREA MUST BE COMPLETED IN FULL
Please state the nature of the offense in detail. The Humane Society of the Treasure Coast has the right to refuse any person . No animal cruelty charges are accepted. No exceptions.
Criminal Offense Charge:
Criminal Offense Details:
Hours Needed:
Date hours need to be completed:
Name of Probation Contact:
Organization:
Phone Number:
Email:
By submitting this form you agree with our terms and conditions as found here.
 
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Humane Society of the Treasure Coast
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Palm City, Florida 34990
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admin@hstc1.org

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