Coastal Area Driving Academy Registration Form

Coastal Area Driving Academy Registration Form

Welcome! Please fill out the registration form and choose your classroom choice. Thank you for choosing Coastal Area Driving Academy!
Class Choice- Belfast High School, Mt. View High School, or Bucksport High School - HYBRID
Student Legal Name*

First Name Middle NameLast NameSuffix
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone Number*
Please enter a valid phone number.
Student Email (email will be sent to the student)*
example@example.com
Student's Date of Birth (proof of DOB required by BMV mandatory prior to first day of class via birth certificate or current passport)*

MonthDayYear
Date
Please Upload Proof of Student Date of Birth.

Cancelof
By State of Maine Law, students must be 15 years of age on the first day of class. Proof of age is required to enroll in Driver’s Education and is needed attached with this registration form. If the student registered is at least age 15 on the first day of class, the deposit is non-refundable. Student will be placed in the next available, open class that is not full class, as their age permits. The deposit will be held a maximum of 6 months from the date of the original application. After 6 months the deposit is forfeited and will not be credited toward another class. Any copy of birth certificate, passport or other legal document showing proof of their date of birth is acceptable.
Student's Age on the First Day of Class:*
Student Gender*

MaleFemaleNon-Binary
Does the student have any of the following medical conditions? (Check all that apply)*
If you selected any medical conditions from above, please explain below:
*Parent/Guardian Information Required if Student is Less Than 18 Years of Age* Please select if you are the Parent, Guardian, or Payee

ParentGuardianPayee
Parent/Guardian or Payee Name-

PrefixFirst NameLast Name
Parent / Guardian or Payee Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent /Guardian or Payee Contact Number
Please enter a valid phone number.
Parent / Guardian or Payee Email (email will be sent to Parent/Guardian/Payee)
example@example.com
Belfast Area High School 5:00 pm -8:00 pm and Mt. View High School 3:15 -6:15 pm - HYBRID classes (unless otherwise indicated) - Choose your class date.
Bucksport High School - HYBRID classes - 3:00 pm - 6:00 pm - Choose your class date.
We will be teaching the curriculum from AAA “How to Drive, 15th Edition" via Powerpoint. If you choose to purchase the textbook outright or E-book to have in addition to what's taught in class, it can be done at the following link: https://drivertraining.aaa.biz/products/how-to-drive-student-textbook. This is optional.

Please Select Payment Options: Option 1: $200.00 Deposit needed to hold your seat in class. ($350.00 due on first day of Class.) Option 2: Pay in Full- $550.00

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Student's Signature:*

Clear
Parent/Guardian Signature:

Clear
Should be Empty: