Class Registration

This registration is for 30 hours of classroom instruction and 6 hours of behind the wheel training, driving only, and Teen Road Test. Please select one session from the following options in which you are choosing to enroll. Driving time is separate from classroom instruction and the driving instructor will set this up with you individually. For driving only and Teen Road Test, please complete this registration form and select the appropriate drop down for which you are registering and someone will contact you to setup a time. If you need to contact us, please call 910-902-1914 or email choppy1914@gmail.com

Parent Name

First NameLast Name

Parent E-mail

example@example.com

Parent Phone Number

Please enter a valid phone number.

Student Name(As on the Birth Certificate)

First NameMiddle NameLast Name

Student Phone Number(If applicable)

Please enter a valid phone number.

Student Birthdate(Month, Day, Year)

List of Classes

Any special concerns or modifications needed in the classroom or in the car?