38 Hour Teen Class 3/04/2019
Drive Dat Academy would like to make your experience in our driving school first class. Please remember to go to the Office of Motor Vehicles to obtain the Temporary Instruction Permit. Also fill out the information below so we can prepare the documents with your information in order to save you the time from filling out the forms during the parent orientation. Drive Dat Academy would like to thank you for choosing us for your driving education specialist. We will see you Saturday 3/04/2019. Remember Registration begins at 8:30 AM and parent orientation begins at 9:00 AM. Please make sure you have this form filled out by 5:00 pm Friday 3/01/2019.
Email address *
The applicant is my *
First Name *
Middle Name *
Please write the Full Middle Name
Last Name *
Date of Birth *
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/
DD
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YYYY
Age of Student at the Time of Taking Class *
Sex *
Eye Color *
Height in Feet *
Inches *
Students Weight in Pounds *
Hair Color *
Does the student wear glasses or contacts *
Home Adress *
City *
State *
Zip Code *
High School *
Grade Level *
Parent's First Name (attending Orientation) *
Parent's Last Name (attending Orientation) *
Parent's Drivers License (attending Orientation) *
We need the Drivers license number of the parent which will be attending the parent orientation
Home Phone Number *
Parent's Cell Phone NUmber *
Students Cell Phone Number *
1. Does the student have any medical conditions that would pose a concern with the student’s behind-the-wheel instruction (epilepsy, asthma, color blindness, hearing loss, etc.)? *
2. Does the student have any mental or physical impairment which could affect his/her ability to drive a motor vehicle safely? *
3. Has the student experienced unconsciousness other than normal sleep? *
4. Is the student’s visual acuity at least 20/40 corrected? *
5. Does the student require any special accommodations to participate in this course (i.e., oral tests, interpreter, seating arrangements, adaptive equipment)? *
Describe locations where the student has driving experience. Check the appropriate box(es) *
Required
Email Address for parent *
Email Address for Teen *
A copy of your responses will be emailed to the address you provided.
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