After filling in this form, print and bring this form with payment into our office
on or after
April 11, 2008. Registration for this class will only be taken in person
on a first come, first serve basis, starting at 8:00 AM, Friday, April
11, 2008.
Student Last Name:
First Name:
Middle Name:
Student's Social Security Number:
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:
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 2008
- 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: $25.00
Payment Method:
Cash
Check (payable to MWSU)
_____________________________________________________________________
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
Check (payable to MWSU)
|