Student's
Full Name:
Last: ________________________ First:
_________________________ Middle: _________________ |
Street Address:
____________________________
City: ____________________________________
County: ______________________ Zip: ________ |
Mailing Address:
__________________________
City: ____________________________________
County: _______________________ Zip: _______ |
Student's Phone:
Home: _________________ cell:
_____________Date of Birth: _____________________________
(month / day /
year)
|
Parents' Phone:
Mom Work: ____________ Dad Work: __________Mom cell
_____________ Dad cell
____________
|
| Permit Number:
_______________________
OR Height: _______ Weight: ______ Eye Color: _______ |
Student must be at least 15 on first class day. If
a student does not have a permit upon enrollment and is
paid in full, a waiver will be issued no more than 7 days before the first class session. A waiver is
required for a permit if the student is not yet 15 1/2
years old. The student must have a permit at least
6 months, complete a driver's education course, and be
at least 16 years old to obtain a intermediate driver's
license.
|
Contact
person: ____________________________
(Other than parent or
guardian) |
Relation
to Student: _________________________
Phone: ___________________________________ |
Earliest Possible Start Date:
_______________________
Check all possible
class days and times below. The course schedule
will be set so all students will be able to attend all
classes. Students must attend all classes. |
During school year
- 7 1/2
week course
Possible Class Days:
Mon/Wed
____ Tues/Thurs ____ Sat/Sun ____
Possible Class Times:
4pm -
6pm ____ 6pm - 8pm ____ |
During Summer
Only- 5 week
course
Possible Class Days:
Mon/Wed/Fri ____
Possible Class Times:
10-12am ____ 4-6pm ____
6-8pm ____ |