Safety 1st Driving Academy Registration
Student Registration 
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Student's First, Middle, and Last Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
Student's Address
Student's Tip Card Number
Student's Tip Card Issue Date
Email Address
Student's Grade (If applicable)
Student's School
Parent/Guardian Name and Contact Number 
Student's Contact Number
Student's Driving Experience (Check all that apply)
Which class are you registering for? (Choose One) *
Required
Payment Options
How would you like to pay?
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