Driver Ed Registration
Lewis County Driving School
1009 Kresky Ave.
Centralia, WA 98531
360-330-0344 (Voice)


Please fill out this form to register for Driver Education at Lewis County Driving School. Orientation Meeting for the parent and student will be on the date listed below at 6 pm online. Class will start the next day at the time listed.
Special changes during the 'shelter in place' recommendation will include online classes using zoom and the payment plan option.
Payment needs to be made the week prior to the start date to guarantee a spot in class, payment plan possible if needed. Credit Card payment may be made over the phone. THANK YOU for choosing Lewis County Driving School !
Choose the preferred start date from this dropdown list: *
Student's Last Name *
Use full legal last name
Student's First Name *
Use full legal first name
Student's Middle Name *
Use full legal middle name
Student's Birth Date *
Input as **/**/**** (mo/day/year)
MM
/
DD
/
YYYY
Street Address *
Your house address (residence, not a post office box)
City *
The city where you live
County *
The county you live. Like Lewis, Thurston, etc.
Zip *
Your city's zip code. Enter as (xxxxx)
Mailing Address (if different)
Enter ONLY if your mailing address is different than your residence.
Mailing Address City
If different
Mailing Address Zip
If different. Enter as (xxxxx)
Home Phone
Input as (***)***-****
Student's Phone
Input as (***) ***-****
Does the student text?
Parent #1's Cell Number
Input as (***) ***-****
Does the parent text?
Parent #1's Relation *
Parent #2's Cell Number
Input as (***) ***-**** Leave blank if not applicable
Does the parent text?
Parent #2's Relation
Leave blank if not applicable
Student's Permit Number
If none, then GO TO --- http://www.dol.wa.gov/driverslicense/preapply.html --- and pre-apply now. The student's permit # should start with WDL (for Washington Driver License). (Enter permit number using CAPITAL letters only.)
Permit Expiration Date
Found on the permit. Enter xx/xx/xxxx, month/day/year IF available.
MM
/
DD
/
YYYY
Student must be at least 15 on first day of class. If a student does not have a permit upon enrollment and is paid in full, a waiver will be issued no more than 10 days before the first class session. The student must have a permit at least 6 months, complete a driver's education course and be at least 16 years old to obtain an intermediate driver's license.
Emergency Contact Name *
OTHER than PARENT or GUARDIAN
Emergency Contact's Relation to Student *
NOT PARENT or gaurdian.
Emergency Contact's Phone Number *
Enter as (***) ***-****
Best GMAIL.COM email address for Student *
Parent Name
Enter parent or guardian's name
Note:
Please enter any other information that we should know to make this a successful experience for your student. Thank you!
====*** OFFICE USE BELOW WHEN PRINTED ***====
Parent Signature: _________________________

Print Name: _____________________________

Date: __________________________________
Submit
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