First Name *First
Middle Name *Middle
Last Name *Last
Student's phone (optional)
Email address *
Driver permit number *
Date of birth *
School attended this year *
Drive request times Please review drive times on your district's Class Brochure (PDF). (Priority will be give in the order that registrations are received.)
Choice #1 *
Choice #2 *
Choice #3 *
Choice #4 *
Choice #5 *
Do you attend special education or have an IEP? *YesNo
What accommodations does your child need? *
Parent's phone number *
Address *Street Address
City
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ZIP / Postal Code
I have read and accept the terms of the Statement of Voluntary Consent, General Release and Waiver of Responsibility *
General Comments (optional)
First name *
Last name *
Street address *
Street address 2 (optional)
City *
State *Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)
ZIP Code *
Country *
Phone *
The Free/Reduced Fee Waiver can be found at your school district Administration office. Your home school district determines waiver eligibility after your waiver paperwork is submitted back to your district administration office.
I do not qualify for reduced nor free registration.I qualify for reduced registration.I qualify for free registration.
June 10 - June 29, 2024 State Approved Driver Education Program: Thirty hours ON-LINE instruction. Six hours behind-the-wheel instruction.
Credit card
Pay with your credit card via Authorize.Net.
Card number *
Expiry (MM/YY) *
Card code *
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