Driving Course Registration

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How did you hear about us?
Students MUST receive their TIP Cards at least 2 weeks PRIOR to the first day of class.
The cost of an additional 8 Hours of Behind-the-Wheel instruction is $350.
Gender
Date of Birth
Student's Home Address:
We communicate the student's driving schedule as well as important information about the class through email. Please list a VALID email that is checked regularly.
Parent/Legal Guardian's name:
Is the student currently attending Highschool?
Does student wear glasses or contacts?
Do you have any allergies we need to aware of?
Does the student suffer from anxiety or any other diagnosis that we should be aware of prior to class attendance or behind-the-wheel training?
Do you give your permission for immediate medical treatment as required by the judgement of the attending physician:
Please confirm that you have listed your FULL NAME! This includes FIRST NAME, MIDDLE NAME (do NOT put an initial), and LAST NAME as listed on your Birth Certificate/TIP Card.
Clear Signature