Andale Summer Driver's Ed Enrollment Form
Please fill out the entire form completely and accurately to enroll in the
2019 Summer Driver's Education program at Andale High School (applicants must be a Renwick student). Your enrollment is not complete until Andale High School receives your payment of $175 (checks payable to Andale High School will be collected at the enrollment meeting).

Parent and the student MUST attend the mandatory enrollment meeting on Thursday, April 11th at 6:30 p.m. in the AHS Auditorium. We will discuss the summer schedule and class expectations, answer questions regarding the online enrollment form, collect the $175 enrollment fee, and have you sign the enrollment forms. If you have any questions, please contact Jeff Buchanan at 316-444-2607 or email jeff.buchanan@usd267.com

Email address *
Legal First Name: *
As it appears on Birth Certificate and/or Social Security card
Your answer
Middle Name: *
Your answer
Last Name: *
As it appears on Birth Certificate and/or Social Security card
Your answer
Suffix:
(II, III, Jr.)
Your answer
Student Phone Number: *
Type in this format: XXX-XXX-XXX
Your answer
Street Address: *
Your answer
Address Line 2 (if necessary):
(P.O. Box)
Your answer
City: *
Your answer
State: *
Zip Code: *
XXXXX
Your answer
Gender: *
Date of Birth: *
XX/XX/XXXX
MM
/
DD
/
YYYY
Eye Color: *
Do you wear corrective lenses or contacts? *
Height: *
(Example: 5' 9" - round to nearest inch)
Your answer
Weight: *
(lbs)
Your answer
Please check your preferred classroom session dates: *
(Classroom portion of Driver's Ed only meets for 5 days. It is mandatory that the student attend all 5 days in order to pass the course! Your selection below DOES NOT guarantee that you will be assigned to that particular session. The times/dates listed below DO NOT include the days the student will be driving. Those dates will be assigned after enrollment has been completed).
Please check any week between May 20 - July 20 you would NOT be able to drive:
Most driving takes place in the morning or early afternoon on each day during the student's assigned driving week. If you have a particular part of the day you are unable to drive, please specify that in the next question instead of marking that you can't drive an entire week. Please limit the number of weeks you check "not available" - this makes scheduling extremely difficult
Please list any other information that will assist us in enrolling your son/daughter into the Driver's Ed program at AHS
Planning to attend morning weightlifting, basketball camps/workouts, volleyball camp, any other conflicts or concerns? Listing does not guarantee we will be able to schedule around everything!
Your answer
List other students enrolled in drivers education that live near you:
(this will help us with grouping students during the driving portion of class)
Your answer
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