Obviously the "program manager" who gave this person the slip has no clue about the programs listed on the slip. I doubt if I would've filled it out, but if I did...here's how I would've done it:
Joe Blow, Client
Meeting type (circle one)
NA AA CDA CR Other____
Date/Time_____
Meeting starts @ 4:30 ends @ 6:00__________
Group Leader (Secretary) Name (full name)_____
GLW_________
Leaders' certification (signature) __________
GLW__________________
Leaders' Contact Phone Number____________
N/A________________
By signing this, I _______
N/A____________ certify that Joe Blow has attended a full meeting of ___
N/A____ and that s/he has participated fully, and was prompt and attentive, and was not disruptive in any way.
As a kicker, I may have also [1] provided a web address to the link on court cards at NA.org, [2] a brief definition of anonymity, and [3] a suggestion that the person who requests all this "babysitting" escort their client themselves if they want verification of the things on the slip.
G