MDPD Community Service Registration Form

Registrant Information

First Name

Middle Name

Last Name

Date of Birth

Race

Sex

Please select one of the following to describe the purpose for completing community hours*:

Civil Citation (Diversion Program Community Hours)
Probation (Court Assigned Community Hours)

Diversion Program Community Hours

Citation Violation Number* (A letter followed by 6 numbers, can usually be found on the top right corner of the citation (Example: G123456)

Please fill out the conviction details below. If you were issued a civil citation and have a criminal past, fill out your latest conviction details below. If you were issued a civil citation and do not have a criminal past, skip this part.

Court Case Number

Sentence Date

Probation Officer Name

Probation Officer Phone Number

Probation Officer Email Address

Charges

Hours Assigned

Completion Deadline Date

Please check one of the following*:

Court Advocate Program
Court Options Program
Other

Registrant Information

Home Address

Apt #

City

State

Zip Code

Primary Phone Number

Secondary Phone Number

Email Address

Driver's License Number

Medical Conditions

Prescriptions

Emergency Contact Name

Emergency Contact Phone Number

Registrant Description

Country of Ethnicity

Speech

Eye Color

Complexion

Build

Hair Length

Hair Color

Hair Style

Facial Hair

Teeth

Height

Weight

Are you of Hispanic or Latino, or Spanish origin?

Yes
No

The locations listed below are the only options available through our program. Please select three locations at which you would like to work.

If you have been convicted within the past five (5) years of any of the laws that fall under the Shannon Melendi Act (see below) you will not be able to do community service hours a park. You must instead choose either Public Works North or Public Works South.

Haulover Park
10800 Collins Avenue
Miami Beach, FL 33167
Monday - Sunday 8 a.m. -3 p.m.

Tamiami Park
11201 SW 24 Street
Miami, FL 33165
Monday - Sunday 7 a.m. - 3 p.m.

Miami-Dade County Beach Operations
7929 Atlantic Way
Miami Beach, FL 33141
Monday - Sunday 5:30 a.m. -2 p.m. (8 Hours)
7AM-11AM (4 Hours)

Kendall Indian Hammocks Park
11395 SW 79 Street
Miami, FL 33173
Monday - Friday 7 a.m. - 3:30 p.m.
(must work a minimum of 4 hours a day)

Crandon Park
6747 Crandon Blvd
Key Biscayne, FL 33149
Monday - Sunday 6:30 a.m. -3 p.m.

Public Works North
7910 NW 27th Avenue
Miami, FL 33147
Monday - Friday 8 a.m. - 3 p.m.

Tropical Park
7900 SW 40 Street
Miami, FL 33125
Monday - Sunday 7 a.m. - 3 p.m.

NOTE: If you select Haulover Park, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

NOTE: If you select Miami-Dade County Beach Operations, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

NOTE: If you select Crandon Park, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

NOTE: If you select Tropical Park, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

NOTE: If you select Tamiami Park, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

NOTE: If you select Kendall Indian Hammocks Park, the background check process may take 1-2 months to complete. If you need to start working on your community service hours as soon as possible, you must select Public Works – North

*Shannon Melendi Act (Miami-Dade County Code, Section 26-39)

Any employee or volunteer of the Miami-Dade Park and Recreation Department who:

(1) Has been convicted of a violent felony or conspiracy to commit a violent felony within the past five

(5) years; or

(2) Has been convicted of a felony involving trafficking of a controlled substance within the past five

(5) years; or

(3) Has two (2) or more convictions for a violent felony, for conspiracy to commit a violent felony, or

involving the trafficking of a controlled substance; or

(4) Is a sexual offender or sexual predator; or

(5) Has failed to provide the Miami-Dade Park and Recreation Department with proof of United States

Citizenship or legal immigration status in the United States; shall be prohibited from working or volunteering on park property owned or operated by MiamiDade County.