Student's
Full Name:
Last: ________________________ First:
_________________________ Middle: _________________ |
Street Address:
____________________________
City: ____________________________________
County: ______________________ Zip: ________ |
Mailing Address:
__________________________
City: ____________________________________
County: _______________________ Zip: _______ |
Student's Phone:
Home: _________________ cell:
_____________
text: yes ___ no ___
Date of Birth: _____________________________
(month / day /
year)
|
Parents' Phone:
Mom Work: ____________ Dad Work: __________Mom cell:
_____________ Dad cell:
____________
text:
yes ___ no
___
text: yes ___ no ___
|
Permit Number:
_______________________________________ |
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 10 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:
_______________________
See all possible
class days and times below.
The course schedule
will be set at or prior to the orientation meeting so all students will be able to attend all
classes. Students must attend all classes.
See web or call for class start dates. |
5 week course
Class Days: T/W/Th
Class Times: 3:30pm to
5:30pm or 6pm to 8pm |