MS Driving Instruction Drivers Ed Registration Form
New London Drivers Education Class 2020/2021 School Year

KEEP SCROLLING DOWN FOR CLASS TIMES AND PRICING
Email address *
Students First MIDDLE and Last Name: AS IT APPEARS ON THEIR BIRTH CERTIFICATE *
Students Email Address . PLEASE USE A NON SCHOOL EMAIL IF POSSIBLE. SCHOOL EMAIL BLOCKS VIDEOS *
Students Cell Phone if they have one
Students Date of Birth *
MM
/
DD
/
YYYY
Address: *
City, Zipcode *
Parent or Guardian's Name: *
Parents Email Address *
Parents / Guardian Phone: *
Class Fee *
Name of the Person who referred you:
*
Class
Classes are held at 775 Industrial Loop Rd... Ort Trucking Building GO STRAIGHT ON BECKERT RD to the Industrial Loop
We are in the Ort Trucking Building.

With Covid Regulations in Place, I will be evaluating monthly if I am able to have Physical Class. You may continue to register for class online or physical class.
*
I need a ride from school to Drivers Ed ( Sept. - May ) NEW LONDON STUDENTS *
Required
Anything you think Ms. Becky needs to know
YOU WILL GET AN EMAIL CONFIRMATION WHEN YOU SUBMIT THIS FORM. If you DO NOT get a confirmation, I DID NOT get your registration.
A copy of your responses will be emailed to the address you provided.
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