Driver Education Enrollment Form
This form will provide the necessary information for enrollment in USD 243 Lebo-Waverly's summer Driver Education Classes. Student and Parent information is used ONLY for class or driving contact. Payment for class can be made the 1st day of class. If payment arrangements need to be different, please contact Doug Piper. (785.229.5732 or dpiper@usd243ks.org)
Email address *
Which school will you be attending Driver Education Class?
Student's First Name, Middle Initial, Last Name (Example: John Q Smith) *
Your answer
Date of Birth (Example: 10/12/2006) *
MM
/
DD
/
YYYY
Home Address (Example: 12534 West 4th Street, Anywhere, KS 67891) *
Your answer
Parent or Guardian First and Last Name (Example: Jimmy Good) *
Your answer
Parent or Guardian Phone Number (Example: 785-879-5642)
Your answer
Student's Cell Phone Number (Example: 620-360-7319)
Your answer
Submit
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