DRIVERS EDGE REGISTRATION KINGSWOOD

STUDENT NAME

First NameMiddle NameLast Name

STUDENT NAME

First NameLast Name

Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Phone Number

Area CodePhone Number

Email

example@example.com

DOB

CLASS DESIRED

PARENT/GUARDIAN NAME

PARENT/GUARDIAN Phone Number

Area CodePhone Number

Email

example@example.com

Current estimated driving hours

Current School Attending

Physician Name and Phone Number

PARENT/STUDENT PERMISSION FORM:

I have read the policies and procedures ( located on www.driversedgenh.com website) and agree to the Drivers Edge Driving School police as described and agree to abide to all the rules.

STUDENT SIGNATURE PLEASE PRINT NAME

My Son/Daughter has my permission to be enrolled in this driver education program. In the event my son/daughter sustains any injury during his/her participation in the program, I hereby giver permission for him/her to receive emergency medical care as deemed necessary by medical personnel. I hold harmless and release from liability GWRSD, Brewster Academy, and Drivers Edge Driving School, LLC and its employees.

I have read and agree to comply with the Driver Education Course Guidelines.

Signature Please print name

MUST BE ANSWERED AND INITIALED PER STATE REGULATION

1. Are the driving privileges for the person enrolling in this program currently under suspension or revocation?

YES/NO

2. Is there any pending action against the person enrolling in this drivers education program that could cause the driving privileges to be suspended or revoked in the future?

YES/NO

The cost of the course is $600.00. Please submit a $300.00 deposit (or payment arrangment) to hold a spot. Please make check payable to Drivers Edge Driving School and mail to Drivers Edge Driving School, 69 Durgin Road, Center Tuftonboro, NH 03816 or drop at the school office. Credit card and Venmo payments are available on my website at www.driversedgenh.com.

PLEASE NOTE THIS CLASS IS FILLED ON A FIRST COME FIRST SERVE BASIS. I LOOK FORWARD TO HAVING YOUR CHILD IN CLASS AND BEHIND THE WHEEL!