Florida Sheriffs Association Teen Driver Challenge Online Application

Florida Sheriffs Association Teen Driver Challenge Online Application
Please note: Completing this application does not secure a spot in a future TDC course. Once your application is reviewed, you will receive a full registration packet via email, which must be completed and delivered prior to the application deadline.

N/A should be used in areas that do not apply to the student
STUDENT INFORMATION
Name

First NameLast Name
Date of Birth

MonthDayYear
Race/Ethnicity
Sex
Driver's License / Learner's Permit Information
Driver's License / Learner's Permit Number
State
Contact Information
Address

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (If different from above)

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
High School
Grade
Student Email
example@example.com
Parent/Legal Guardian Name

First NameLast Name
Parent / Legal Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Legal Guardian Email
example@example.com

Please note: Completing this application does not secure a spot in a future TDC course. Once your application is reviewed, you will receive a full registration packet via email, which must be completed and delivered prior to the application deadline.