Driver education Enrollment Form

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 NameLast 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.

MonthDayYear
Date
Does the student have a Learner's Permit? (Instructions for getting the permit will be included in the Confirmation)

YESNO
ADDRESS: This must be the student's actual address. No P.O. boxes or pseudo addresses

Street Address

Street Address Line 2

CityState / 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 NameLast 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

5PM6PM7PM8PM
School year: THURSDAY

5PM6PM7PM8PM
School year: SATURDAY

1PM2PM3PM
School year : SUNDAY

10AM11AM12PM1PM2PM
Summer: TUESDAY

10AM11AM12PM1PM2PM3PM
Summer: THURSDAY

10AM11AM12PM1PM2PM3PM
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

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Enrollment Form

FEE: $1375. (includes testing)