AK Drivers Training Registration
All areas marked with an asterisk (*) is a required field and must be filled out. If the question does not apply please mark N/A.
Are you interested in AK Drive's Drivers Training or Permit class? *
What month would you like to participate in AK Drive DRIVER TRAINING or PERMIT CLASS? (see schedule on akdrive.org) *
Your answer
Do you have an Alaska Learners Permit? *
If you do not have an Alaska Learners Permit you do not qualify for this class.
List your Alaska Learners Permit Number *
if not applicable, type N/A
Your answer
List your Alaska Learners Permit Number expiration date *
if not applicable, type N/A
Your answer
Participant First Name *
Your answer
Participant Last Name *
Your answer
Participant Mailing Address *
Your answer
Mailing City and Zip Code *
Your answer
Participant Home Address *
Your answer
Home City and Zip Code *
Your answer
Participant Home Phone # *
Your answer
Participant Cell Phone # *
Your answer
Participant Cell Phone SMS/Text Message Compatible *
Required
Participant Email Address
Your answer
Participant Birthdate *
Your answer
Participant Age *
Your answer
Participant Gender *
School Name (if currently enrolled) *
if not applicable, type N/A
Your answer
Participant Parents Name: (if under 18 years old) *
if not applicable, type N/A
Your answer
Participant Guardians Name:(if under 18 years old) *
if not applicable, type N/A
Your answer
Parent/Guardian Mailing Address:(if under 18 years old) *
if not applicable, type N/A
Your answer
Parent/Guardian City and Zip *
if not applicable, type N/A
Your answer
Parent / Guardian Email Address: *
if not applicable, type N/A
Your answer
Parent / Guardian Home Phone *
if not applicable, type N/A
Your answer
Do you have a mental or learning disability that could affect your ability to drive? *
Briefly explain.
Your answer
Parent / Guardian Cell Phone *
if not applicable, type N/A
Your answer
Parent / Guardian Cell Phone SMS/Text Message Compatible
Do you have a physical disability that could affect your ability to drive? *
Briefly explain.
Your answer
Do you take medication that could affect your ability to drive? *
Briefly explain
Your answer
Do you wear any required corrective lenses? *
These must be wore at all times while driving
How did you hear about AK Drive? *
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