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Melcher-Dallas Driver's Education Registration
This is the official registration form to take Driver's education classes.
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* Indicates required question
Email
*
Your email
Student first name
*
Your answer
Student last name
*
Your answer
Driver License Number
Your answer
Student Address (Street, City, Zip Code)
*
Your answer
Student Phone number
Your answer
Parent Email address
Your answer
Parent contact Name
*
Your answer
Parent Phone Number
*
Your answer
Do you receive Text messages?
*
Yes
No
Does student have any physical or learning disabilites or a current IEP, 504 plan or language barrier that require special accomodations?
Yes
No
Clear selection
If yes, explain
Your answer
If student attends a district that has a contract with Training Wheels, LLC. Please check the appropriate box below if it applies to you. Otherwise leave the question blank.
We receive free lunches
We receive reduced lunches
A copy of your responses will be emailed to the address you provided.
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