Driver Education Registration 2018
The following form will be used to register the upcoming session's students for Driver Education. An updated roster will be posted soon.
Last Name *
First Name *
Birthdate *
Please list as 9/29/1997
Applicant Cell Number *
Does the applicant have a Learner's Permit? *
If the permit is not shown to the instructor on the FIRST day of class, the student will be dismissed.
Please enter your LIVING address (this will be for creating the DE certificates, NOT mailing them).
Street Address *
City *
Zip Code *
Approximately how many hours of supervised driving does the applicant have? *
Parent first and last name *
Parent Cell Number *
Parent Email
Student Email
Parent #2 Email (if needed)
Parent #2 Cell Number (if needed)
Important Comments
Please comment if applicant has a color blindness, medical condition or any concerns you might have as a parent.
Acceptance of Terms, Rules and Expectations *
By marking YES, we (parent and student) have either attended the meeting AND understand all rules and expectations OR have read through the presentations AND accept all rules and expectations.
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