Hands-On Driver Training Registration Form
Please complete the form below to register for the class scheduled for:
NEXT CLASSES: July 10 ~ Aug. 14 ~ Sept. 11 ~ Oct. 9 ~ Nov. 13 ~ Dec. 4
@ Holiday Inn 139 Bradford Blvd, Santee, SC 29142
Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Driver Training/Class Date:
July 10, 2021
August 14, 2021
September 11, 2021
October 9, 2021
November 13, 2021
December 4, 2021
Beginner's Permit #
Type number above
How long have you had your permit?
Enter the approximate number of months.
Date of Birth
-
Month
-
Day
Year
DOB
Email Address
example@example.com
Home Phone Number
-
Area Code
Phone Number
Student Cell Number
-
Area Code
Phone Number
Texting Available?
YES
NO
Select One
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Cell#
-
Area Code
Phone Number
Select a Training Package:
Classroom/Behind-the-Wheel Training: $295.00
Classroom/Behind-the-Wheel Training/Road Test: $310.00
Other Service Selections:
Road Test Only: $50.00
AAA 4-Point Reduction: $100.00
Behind-the-Wheel Only: $60.00
Today's Date
-
Month
-
Day
Year
Date
Student Signature
*
Student Signature
Clear
Parent/Guardian Signature (if trainee is under 18)
Clear
Submit
Clear Form
Print Form
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