Fred Myers' School of Driving
Registration Form
Email address *
Student First Name: *
Student Last Name: *
Student Phone Number ("None" if no phone available): *
Street Address: *
City: *
State: *
Zip Code: *
Parent Name (First and Last):
Parent Phone Number ("None" if no phone available):
School Attending ("Homeschool" or "None" if graduated): *
Date of Birth *
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Permit Number ("NA" if no permit yet): *
Driving Hours Logged (Approximate #): *
License Eligibility Date (6 months from date of permit issue OR today's date if eligible now):
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Testing County (County where you will take your test):
Medical Challenges (vision, health, anxiety, etc.) that may help us during driving instruction:
I understand that I am agreeing to pay Fred Myers' School of Driving the student fee of $230.00 for 6 hours in-class instruction and 6 hours in-car instruction. (Additional hours of in-car instruction are available at a reduced cost)? *
Required
I understand that I must present my driving permit or license before driving sessions. *
Required
I understand that I must must call at least 24 hours in advance if I choose to cancel a schedule driving session. (Call to cancel: 270-443-FRED) *
Required
I understand and agree that I must complete this course within one year (12 months) or I may be charged additional fees. *
Required
I understand that this class is for the registered student and unused sessions are not transferrable to another student. *
Required
Signature (Type your name below to sign and authorize this registration): *
Enter the Date for your Signature *
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Submit
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