Online Registration – Bass Driving School

How did you hear about us? *

Please select your payment method *

Please Select A Course

38 Hour Course Dates (15-17 Years Old)

14 Hour Pre-Licensing Course Dates (18+ Years Old)

Behind-the-wheel driving only (8 hours) **Must have previously obtained classroom portion of instruction.**

Student Information

TIP Card#:

TIP Card Issue Date

TIP Card Information

Please check box stating you understand that you must 1) Obtain a TIP Card from the DMV and 2) TIP Card number and date of issuance must be sent to Bass Driving School at least 1 week prior to class. *

First Name *

Middle Name *

Last Name *

Address *

City *

State *

Zip *

Date of Birth (MM/DD/YY) *

Name of Highschool/Homeschool currently enrolled in. *

What grade is student currently in school?

Does the student require any special accommodations? If yes, please explain. *

E-mail *

Cell Phone or Contact Number *

Gender *

Do you wear glasses or contact lenses?

Parent/Guardian Information

If you are 18 years or older you do not need to complete this section.

Name

Phone

E-mail

Address

City

State

Zip

Registration/Medical Disclaimer

By submitting your application you agree to the following: 1) No refund or partial payment will be given once student enrolls in a course. If student is not able to attend the course initially registered for, they may transfer to another course that has an opening. 2) If student is not able to pass the tests required to complete the 30 hours (for 38 hour course) or 6 hours (for 14 hour course) of classroom instruction and are dismissed from class, there will be no refund or partial payments given. 3) Bass Driving School, LLC. will do all we can to help you succeed. However, we are not equipped, due to time and size of classes, to provide 504 accommodations. If you require these accommodations, please contact the Louisiana DMV for a list of schools that offer such accommodations. 4) Classes are filled on a first registered, first paid basis. Once the class has reached it's max capacity, we will close the class. If you have registered, but not paid by the time the class is closed, then you will not be admitted into the class. Online Registration is pending until payment is made and a seat will not be reserved until payment is received. 5) I waive all legal liability to Bass Driving School in the event of any medical incident, accident, or illness that happens while attending a 14 or 38 hour course with Bass Driving School. I will consent to completing and submitting the medical release form and submit it on the first day of class.

Do you consent to have read and understood the Registration Disclaimer? Click box if "Yes". *

Proof of Enrollment Form Requirement

Please check box stating that you understand that it is your responsibility to obtain the Proof of Enrollment form and if taking a class during the Summer, you must obtain form before the school closes for the Summer break. *

MEDICAL RELEASE AND INFORMATION:

Student's Physician *

Physician's Telephone Number *

Any Allergies? Check box if yes

If yes for Allergies, please list:

Convulsions? Check box for yes.

Blackouts? Check box for yes.

Does student have any other medical conditions that could/would hinder their driving ability? If so, please explain. *

Is student taking any medication currently? If yes, please list. If no, please write "none". *

Prescribing Physician for any medications student currently takes.

Do you wear glasses or contacts? *

Do you have any physical disabilities? If yes, please explain. *

Do you have any mental, social, or emotional problems? If yes, please explain. *

I give my permission for immediate medical treatment as required by the judgement of the attending physician.

I do NOT give my permission for medical treatment until I have been contacted.

Please type your name (Parent or Legal Guardian, or self 18+) specifying that all info provided is accurate and true and that medical attention and actions will occur if needed and if consent is indicated above. *

Online Registration Directions: