Stella Maris Driver Education Registration Form

Stella Maris Driver Education Registration

Fill out the information below. You can pay by check now, or you will be emailed a link for payment closer to the start of class.
Which Driver Ed Session are you interested in?*

Feb/Mar 2025
Student Name*

First NameMiddle NameLast Name
Student's Phone Number*
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Student's school*
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Phone:*
Parent/Guardian Email*
example@example.com
2nd Parent/Guardian Name:

First NameLast Name
2nd Parent/Guardian Phone:
2nd Parent/Guardian Email:
example@example.com
Will you be paying by check or online payment link?

Check (see address to mail to in confirmation email)Online (watch for a payment link closer to the start of the class)
PAYMENT INFO

Classroom Education fee $170 (includes $120 and downpayment for behind the wheel $50)
Remaining BTW balance of $300 due at first BTW session.
Should be Empty: