Driver's Education Registration Form (Driving Portion Only)

Driver's Education Registration Form (Driving Portion Only)
Student's Name*

First NameLast Name
Parent/Guardian*

First NameLast Name
Email Address
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please select one of the payment options below.
Payment Method Check or Cash

SWP Student $295.00NON SWP Student $325.00
Please submit payment to:

Southwest Parke Community School Corporation

Attn: Driver's Education

4851 South Coxville Road

Montezuma, IN 47862
Should be Empty: