THE 2018 WINTER PROGRAM IS NOW FULL
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THE 2018 WINTER PROGRAM IS NOW FULL

 
STUDENT NAME (First, M.I., Last) 

*

 
STUDENT D.O.B.
Must be 15 by class start date *

 
Does the student have a Learner's Permit? *

     
 
STUDENT HOME ADDRESS
(No P.O. boxes or pseudo addresses) *

 
STUDENT'S SCHOOL: *

 
CLASS START DATE:
i.e. 2018 Winter / 2018 Summer / 2018 Fall *

 
PARENT / GUARDIAN NAME: *

 
PARENT / GUARDIAN EMAIL:
(Email, not name please) *

 
PARENT / GUARDIAN PHONE: *

 
STUDENT PHONE #:

*

 
WHERE DID YOU LEARN ABOUT US? *

 
In this section, you will indicate when the student is & is not available for the 6 IN-CAR DRIVES which are separate from the CLASS.

>>>>>  Dec. 5     9:00 AM <

 
MONDAY DRIVE AVAILABILITY:
 
*


 
WEDNESDAY DRIVE AVAILABILITY:

*


 
SATURDAY DRIVE AVAILABILITY:
NOTE: The 12 PM drive starts at out office *


 
SUNDAY DRIVE AVAILABILITY:
NOTE: The 2 PM drive ends at our office *


 
Please indicate when the student IS NOT available for the drives.
Specific dates, days of the week, times.

Please enter: "NO RESTRICTIONS" if that is the case.


*

 
PARENT / GUARDIAN AUTHORIZATION:
By selecting "Yes", you grant the student permission to participate in the driver education program
*

     
 
WHAT HAPPENS NOW?
Within 48 hours (usually sooner) you will receive the Confirmation Package that includes;
• The schedule for the 6 IN-CAR DRIVES
• How to get the Learner's Permit
• Information on the Parent Orientation Session

 
THANK YOU....
We look forward to having your son /daughter in our program!

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