Application

This is the Adult Waiver Application. It's very similar to Driver's Education except it is just for people 18 and older. If you have ever taken the classroom portion in the past you only need to select the Behind the Wheel option below. If you haven't taken the class select the Both option below so we know to send the login credentials for the online class and lets us know to call you and schedule the days for Behind the Wheel.

Name *

First Name Last Name

Previously taken the Classroom Portion *

No Yes

Which Session *

Online Class Behind the Wheel Both

Student Information *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

If online class was selected please use e-mail you want to receive the login information.

Phone Number *

Area Code Phone Number

Date of Birth *

Month Day Year

Learners Permit #

School Attending

A $50 non-refundable deposit is required for the classroom portion due by payment on the website or by check within 7 days of completing this form.

Payment

Deposit $ 50.00

Quantity

Classroom $ 200.00

Quantity

Behind the Wheel $ 300.00

Quantity

Both $ 500.00

Quantity

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Signature *

Clear

Type a question