Take Five Driving Academy Registration

Take Five Driving Academy Registration Form
Legal Guardian Full Name*

Legal Guardian Full NameLegal Guardian Phone Number Legal Guardian Email
Student Full Name*

First NamePlease only list your student number if you give Take Five Driving Academy Permission to contact your child for Driver Ed. Permission Student Contact Number (Type N/A if you do not want your child number as a contact)
Date of Birth Students must be 14 years & 9 months *

DayMonthYear
Copy and Paste the link below to check your student birthday and confirm they will be 14 and 9 months old before their scheduled class.
https://www.calculator.net/age-calculator.html
Gender*

MaleFemale
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note:-

1. No REFUNDS

2. Students must attend 30 hour class, if students miss more than 8 hours, student will have to re-take the FULL 30 HOUR CLASS. (BALANCE CAN BE TRANSFERED ONE TIME)

3. Payment Must be paid in Full in order to secure your students seat.

4. All students must be at least 14 years of age and 9 months old. All students must obtain a (TIP) Temporary Instructional Permit from the DMV before starting class. Make your appointment at the DMV to get your student’s TIP card.

5. Legal Guardian must attend the parent meeting as mandated by the state to complete the necessary forms and receive important information before the first day of class. Please bring your students TIP Card with you.

6. STUDENT CAN NOT DO 8 HOURS BEHIND THE WHEEL UNTIL THEIR 15 YEARS OF AGE
SELECT ONE (IF THE CLASS IS NO LONGER POSTED IT IS FULL)*

December 14, 15, 20, 21 8:00-4:00pmDecember 22, 23, 24, 26 8:00-4:00pmFebruary 15,16,17,18 8:00-4:00pmFebruary 19,20,21,22 8:00-4:00pmApril 12,13,14,15 8:00-4:00pmApril 16,17,18,19 8:00-4:00pmINFORMATION FOR FUTURE CLASSES
Please upload Students TIP Card ****If student has not obtained a TIP Card please visit the DMV*****

Browse Files

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Declaration*

I declare that the above details are complete and correct
I declare that I am the Legal Guardian for the above student. I understand that this course is nonrefundable. I understand that this course can be rescheduled one time. *

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Take Five Driving Academy Registration Form