Form DE

In Car Instruction Sign up Frederick County

Allegany Driving School
Please complete the requested information and submit in order to continue with the driving portion of the program. We will be contacting all students with permits to schedule 6 hours of driving.

If you do not have a Learner's Permit, please wait to complete this form.
Name:*

First NameLast Name
Month you attended class*
Do you have your Learner's Permit?*

YesNo
Learner's Permit Issue Date*
If you do not have a permit yet, please complete when you get the permit from MVA.
Permit ID Number (Customer Identifier)*
We will need this number to send your completion to MVA. (B-555-555-555-555)
Local High School
Parent Phone Number
Please enter a valid phone number.
Student Cell Phone #*
Address*

Street Address

CityState

Postal / Zip Code
E-mail*
example@example.com
Date of Birth

MonthDayYear
Date
I understand the risks involved with learning to drive a motor vehicle as well as the health risks associated with COVID 19 and give Allegany Driving School permission to train and educate this student in accordance with the Maryland Driver Education Curriculum both in classroom and in vehicle.
Please add any addition information below.
Signature

Clear
Parent/Guardian Signature if Under 18. Student Signature if 18 or Older.
Please verify that you are human*
Should be Empty: