Enrollment Form
You will receive a confirmation within the next 3 days that includes; • The in-car drive schedule, • Instructions for getting the Learner's Permit, • Information about the parent orientation sessions (on Zoom), • Payment instructions. If for some reason you don't get the confirmation within 3 days, please contact us at: driveed@gmail.com THANK YOU!
FEE: $1375. (includes testing)
You will be instructed where to send the initial $300. fee in the Confirmation PDF. The $1075. balance is paid at the end of the program.
STUDENT Name (legal first and last name only.....NO NICKNAMES)
First Name
Last Name
WHICH PROGRAM are you enrolling for?
FALL 2024 (Student's D.O.B. must be on, or before Sept. 29 to qualify)
WINTER / SPRING 2025
Student D.O.B.
-
Month
-
Day
Year
Date
Does the student have a Learner's Permit? (Instructions for getting the permit will be included in the Confirmation)
YES
NO
ADDRESS: This must be the student's actual address. No P.O. boxes or pseudo addresses
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
STUDENT Phone Number....Make sure the Student and Parent numbers are NOT the same
Please enter a valid phone number.
STUDENT Email....Make sure the Student and Parent emails are NOT the same
example@example.com
PARENT Name
First Name
Last Name
PARENT Phone Number....Make sure the Parent and Student numbers are NOT the same
Please enter a valid phone number.
PARENT Email....Make sure the Parent and Student emails are NOT the same
example@example.com
School student attends:
Who referred you to us?
WHEN IS THE STUDENT AVAILABLE FOR THE IN-CAR DRIVES? Drives begin & end at your home (or other locations), Students drive for one hour, however allow for up to 90 minutes per drive session (except 8PM which is 1 hour), Please give VERY CAREFUL thought about the student's availability....Once the drives are scheduled, they can be difficult to change
Please enter ALL times the student is available;
School year: TUESDAY
5PM
6PM
7PM
8PM
School year: THURSDAY
5PM
6PM
7PM
8PM
School year: SATURDAY
1PM
2PM
3PM
School year : SUNDAY
10AM
11AM
12PM
1PM
2PM
Summer: TUESDAY
10AM
11AM
12PM
1PM
2PM
3PM
Summer: THURSDAY
10AM
11AM
12PM
1PM
2PM
3PM
Please indicate any dates or times we should NOT schedule in-car drives;
Is there any additional information you want us to have?
I, the parent or legal guardian give my permission for the student to participate in the driver education program. Signature
Submit
Submit
Should be Empty: