Driving School Registration Form

Learn the Right Way Driving Academy, LLC

Registration Form
All students must complete this application form. To apply for driving lessons, kindly schedule your classroom sessions directly on our website. If you require behind-the-wheel instruction only, please reach out to us at 937-977-5989, and our team will be delighted to assist you in scheduling your lessons. We're committed to providing you with a seamless learning experience tailored to your needs, ensuring you gain the confidence and skills to navigate the road safely.
Student Full Name*

First NameLast Name
Student Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email*
example@example.com
Student Phone Number*
Please enter a valid phone number.
Does the students wear*
Which program are you registering for?*

TeenAdultRemedial
Pick Up Location (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you in High School?*

YesNo
If Yes, What is Your High School's Name
Copy of Driver's License or Learner's Permit*

Cancelof
Certificate of Completion

Cancelof
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Parent Email
example@example.com
How did you hear about us?*
As a driving student or parent to a minor under 18, I (we) acknowledge and expressly assume all risks and legal liabilities associated with my participation in activities with Learn the Right Way Driving Academy, LLC. I (we) hereby waive and release all claims for injuries, damages, or loss that may arise as a result of my participation. I (we) understand that I (we) am solely responsible for my own safety both on the premises and while traveling to and from the work sites. Additionally, I (we) certify that I (we) do not have any physical or psychological medical conditions that would pose risks to others or myself in connection with this activity. By submitting this form, I (we) grant Learn the Right Way Driving Academy, LLC permission to use photographs or video footage taken during my participation in publications, presentations, websites, and/or other promotional materials. I (we) willingly provide this authorization to support the efforts of Learn the Right Way Driving Academy, LLC, and understand that this authorization will remain in effect until terminated in writing by either party (emails accepted).
Student Signature*
Date*

MonthDayYear
Date
Parent Signature (Required for Minors under 18 years of age)
Date

MonthDayYear
Date
My Products
prevnext( X )
Teen Program
$420.00 Quantity



Adult Program
$420.00 Quantity



Remedial Program
$125.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

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Learn the Right Way Driving Academy, LLC