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DWI Impact Panel Sign-Up

  1. Please indicate the Court that is hearing your case. If not applicable, please note "N/A"

  2. Please indicate the county of conviction. If you are a self referral, please let us know what county you reside in.

  3. Please indicate the name of the sentencing Judge. If you don't know, please leave blank.

  4. LOCATION: Ontario County Safety Training Facility, 2914 County Road 48, Canandaigua, NY 14424

  5. TIME: Registration begins at 6:15pm and ends at 6:55pm. Impact Panel starts at 7:00pm and ends at 8:30pm. NO LATE ENTRIES ALLOWED!

  6. A $40.00 FEE (EFFECTIVE 04/01/18) IS REQUIRED AND WILL BE COLLECTED DURING REGISTRATION. CREDIT CARD, CASH, MONEY ORDER MADE PAYABLE TO ONTARIO COUNTY WILL BE ACCEPTED. ONLINE CREDIT CARD PAYMENT CAN BE MADE PRIOR TO THE PANEL. THERE WILL BE NO REFUNDS IF YOU ARE DIRECTED TO LEAVE.

  7. • DO NOT DRIVE TO THE VIP UNLESS YOU POSSES A VALID DRIVER’S LICENSE. A DWI IMPACT PANEL IS NOT COVERED UNDER A CONDITIONAL/RESTRICTED LICENSE. • DRINKING OR ILLICIT DRUG USE PRIOR TO ATTENDANCE IS STRICTLY PROHIBITED. ANYONE FOUND TO BE UNDER THE INFLUENCE OF DRUGS/ALCOHOL WILL NOT BE ALLOWED TO ATTEND. • LATECOMERS WILL NOT BE ADMITTED. YOU MUST ARRIVE BEFORE 6:55PM. • ONCE INSIDE THE PANEL, CELL/SMART PHONES ARE NOT ALLOWED. ANYONE FOUND TO BE IN POSSESSION OF/USING A CELLPHONE WILL BE DIRECTED TO LEAVE AND WILL BE RETURNED TO COURT. • NO FOOD OR BEVERAGES ARE ALLOWED INSIDE THE PANEL. • IF YOU FAIL TO COMPLY WITH DIRECTIVES GIVEN BY THE STOP-DWI ADMINISTRATOR AT THE START OF THE PANEL, YOU MAY BE DIRECTED TO LEAVE AND YOUR SENTENCING COURT WILL BE NOTIFIED.

  8. Confirmation and additional information will be sent to your email address.

  9. I ACKNOWLEDGE THE CONDITIONS OF ATTENDANCE AT A DWI IMPACT PANEL. I AM FULLY AWARE OF THE CONDITIONS IMPOSED UPON ME.

  10. Please type your name acknowledging that you have read the terms and conditions.

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  12. This field is not part of the form submission.