Kingstree Location
Applicant Information
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
Date of Class
-
Month
-
Day
Year
Date
Driver Information
Beginners Permit/ Driver's License Number
Date of Issue
-
Month
-
Day
Year
Date
Name of High School if Under 18
Emergency Contact
Name of Parent/ Guardian
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
PLEASE INFORM INSTRUCTOR OF THE FOLLOWING:
Medications While Driving Yes / No PHYSICAL, MENTAL OR LEARNING DISABILITIES
CHECK THE APPROPRIATE BOX FOR THE CLASS IN WHICH YOU ARE INTERESTED
Select All That Apply
Beginning Driver Training(8 Hrs Classroom & 6 Hrs BTW ($285 Kingstree)
Beginning Driver Training( Payment Plan Kingstree $100)
Four Points / Insurance Reduction (8 Hrs Classroom Instruction $100)
2/Hr. Driving Lesson ($80 Kingstree)
Driving Exam ($45 Kingstree)
Permit Test $35
Student / Guardian Signature
Parent/ Guardian Signature
Instructor Signature
Todays Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: