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Subject: *
Student Name: *
Parent/Guardian Name(s): *
Address: *
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Home Phone: *
Student Cell Phone *
Date of Birth (mm/dd/yyyy) *
Age *
E-mail Address: *
Enroll me in: (check all that apply) *Pkg A (D.E, D.T, DRIVE TEST, LA)
Pkg B (D.E, D.T)
Pkg C (D.T, DRIVE TEST, LA)
Behind-the-wheel (only)
DMV Driving Test (only)
Drive LA (only)
Stick-shift training (only)
Classroom Driver Education (only)
I agree to attend a two hour Parent-teacher Workshop so that my teen may receive the Certificate of Completion of driver training (6 hrs in car). Parent Signature:
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