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
Particpant 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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