Teen Driving Registration Form

Date

MonthDayYear
Date
Teen Driving Training Course:

Our goal is to safely teach and train a new generation of drivers one student at a time how to travel the highways, safely and to avoid collisions. We will teach the students how to avoid bad driving habits that lead to many preventable collisions. They will learn how to spot and react to potential hazards. We can be better drivers if we follow the rules, regulations and guidelines set by the DMV. Therefore, our job is to teach the students to always put safety first. By doing these and many more safety tips like it, will change a generation of drivers, and make the highways, roads, and interstates a safer place for all of us.

The teen course consists of 30 hours of classroom instruction teaching key topics such as North Carolina laws, basic car control, defensive driving, alcohol awareness, speeding, adverse conditions, handling emergencies, accidents, insurance, and seatbelt use. Classroom participation is encouraged through classroom activities, lectures, and movies. Behind-the-wheel includes 5 hours of or the road driving instruction.

Driving lesson may take up to 1-3 weeks to be scheduled, after the classroom has been completed.

Each lesson will be 2 hours in either package.
Additional documents for registration

Bring this registration form and the following documentation to first session.

• Original Certified Birth Certificate
• Original Social Security Card
• Current Proofs of Residence (ex. power, water or gas bill)
Preferred Session

WinterSummer
Package Type

Complete Driver Education Package ($795.00)Partial Package ($495.00)
Behind-The-Wheel

This driver’s education session is for 14 1/2 to 17 years old without a permit. Tuition is due in full on the first day of your lesson.

30 hours of classroom must be completed before behind the wheel can be started.
Schedule Preference
Student Information
Name

First NameLast Name
SSN
Birth Date

MonthDayYear
Gender
Ethnicity
Email Address
Phone Number
Please enter a valid phone number.
Grade
Semester
Have you previously applied to or attended this school?

YesNo
If yes, what year?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Student Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

School
School Name
City
State
Date Started

MonthDayYear
Please verify that you are human*
Should be Empty:

Student Information

Current Residence Information

Primary Residence Information (if different from above)

Parent/Guardian Information

Emergency Contact 1

Emergency Contact 2

Student Physician and Medical Information

School