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
Date
Race/Ethnicity*

WhiteHispanic/LatinoAsianBlack/African AmericanHawaiian/Pacific IslanderAmerican Indian/Alaskan NativeOther
Sex*

MaleFemale
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.
Home Phone
Please enter a valid phone number.
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.
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.