Registration Form
After filling in this form, print and bring it with payment into our office on the day registration opens. Registration for this class will only be taken in person on a first come, first serve basis, starting at 7:00 am Friday, April 3, 2009. Registration will be held in the atrium of Spratt Hall. [Student does not have to be present at registration.]
Student Last Name:
First Name:
Middle Name:
Address:
City/State/Zip:
Day Phone:
Cell Phone:
Evening Phone:
School:
Gender:
Date of Birth:
Parent or Guardian:
Address:
City/State/Zip:
Day Phone:
Evening Phone:
Cell Phone:
Email Address:
Student and parent/guardian signatures and photocopy of birth certificate are required for enrollment in this Driver Education Program.
______________________________________________________________________
I, the undersigned, understand and agree that the perspective Driver Education student:
- Meets the Driver Education criteria listed on the previous page
- May register for only one section of Driver Education during 2009
- Forfeits enrollment in the class if I (the student) am tardy or
absent from the first class meeting in which I (the student) am registered - Must attend all class sessions and complete the driving schedules
to receive a certificate.
Student Signature: __________________________________________
Date:
Parent/Guardian Signature: ___________________________________
Date:
Start Date/Class #:
Payment Amount: $35.00
Payment Method:
Cash
_____________________________________________________________________
I do not meet all of the above criteria, but I wish to enroll in Driver Education.
Start Date/Class #:
Payment Amount: $225.00
Payment Method:
Cash
