Driver's Education Registration Form

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Dufrene Driving School

Email *

Student's Name (First & Last Name) *

PLEASE DO NOT SUBMIT ONLINE REGISTRATION FORM IF YOU ARE NOT PAYING ONLINE WITH CARD/PAYPAL. CALL US AT 985-532-6390 IF YOU WOULD LIKE TO MAKE AN APPOINTMENT TO PAY WITH CASH OR CHECK. STUDENT'S INFORMATION WILL BE OBTAINED THEN.

Student's Date of Birth *

YYYY

Contact Number w/ Area Code *

Email Address *

PLEASE ENTER THE EMAIL ADDRESS WHERE YOU WANT THE CLASS INFORMATION SENT TO

Select a Class from Options Below *

38hr Classes are for students under the age of 18; 14hr Classes are for any student over the age of 18

14hr Class, Saturday June 4 at 8am in Thibodaux

Paying Off Balance (not registering for a class)

Select Payment Amount *

ALL ONLINE PAYMENTS WILL INCLUDE A 4.4% SERVICE FEE. IF YOU PREFER TO PAY VIA CASH OR CHECK, PLEASE CALL 985-532-6390.

38hr Course- Full Payment $425

38hr Course- Deposit Only $200

38hr Course- Remaining Balance $225

14hr Course- Full Payment $325

14hr Course- Deposit Only $175

14hr Course- Remaining Balance $150

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