April 21 Laplace Location Road Skills Test Registration

April 7 Laplace Location Road Skills Test Registration
All applicants must have had their Louisiana Learner's Permit for a period of at least 180 days and must be 16 years of age. If the applicant is 17 or older they can take the roadskills test at any time. Applicants 17 and younger must have parent with them to sign permission forms.
DATE:

Month Day Year
Date
FIRST AND LAST NAME OF APPLICANT *
DATE OF BIRTH (MTH/DAY/YR) *

Month Day Year
Date
LEARNER'S PERMIT NUMBER *
Email *
example@example.com
APPLICANT'S CELL PHONE NUMBER *
Please enter a valid phone number.
Do you were glasses or contacts *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
LICENSE STATE
LEARNER'S PERMIT ISSUE DATE *

Month Day Year
Date
Fill out parental information only if the applicant is 17 and younger.
PARENT'S CELL PHONE NUMBER *
IF 17 OR YOUNGER (enter 0 if 18 or older)
PARENT'S FIRST AND LAST NAME *
IF 17 OR YOUNGER (enter 0 if 18 or older)
License/ID No. of Parent/Guardian *
IF 17 OR YOUNGER (enter 0 if 18 or older)
Appointment (please arrive 10 minutes prior to appointment) *
Vehicle Make/Model
YEAR
PLATE #
EXAMINER ID #
TYPE OF PERMIT
Please be at our office 10 minutes prior to your scheduled appointment. If you are not there 10 minutes prior to the time of your appointment, we will not be able to perform your test. I am paying a $20 nonrefundable deposit to hold the appointment spot. An additional $40 cash is due at the time of test. *

I understand
NON Refundable Road Skills Test Deposit *
prev next ( X )
NON Refundable Road Skills Test Deposit This is a non-refundable deposit to hold a spot for a road skills test. This deposit is not transferable to another testing date. The remaining balance is $40.00 cash.
$ 20.00

Total

$ 0.00
Location
Should be Empty:

April 7 Laplace Location Road Skills Test Registration