14-16 YRS OLD DRIVER ED REGISTRATION FORM

KEYS 4 SAFE DRIVING REGISTRATION FORM
Date

MonthDayYear
Date
Course Options
Classroom Course Dates:
Please select the class/course date you would like to attend for Driver's Education. For additional information, all class times are listed with the class dates on the website under the "Classes" tab. ***14 HOUR = ADULTS | 38 HOUR = TEENS****
STUDENT INFORMATION
Name of Student (PRINT First/Middle/Last):
**Please type: FIRST, MIDDLE, and LAST NAME**
TIP #:
TIP Issue Date:

MonthDayYear
Date
Home Address:

Street Address

Street Address Line 2

CityState

Zip Code
Date Of Birth:

MonthDayYear
Date
Age:
Student email address:
example@example.com
Legal parent/guardian email address:
example@example.com
CONTACT PHONE NUMBERS
Student Contact:
Format: (000) 000-0000.
Parent's Contact:
Format: (000) 000-0000.
Alternative Contact:
Format: (000) 000-0000.
PARENTAL/GUARDIAN CONSENT- TO BE COMPLETED IF STUDENT IS A MINOR
I do hereby certify that I am the Legal Parent/Guardian of the minor applying and this is my authorization to the above named Driving School to administer the driver education course indicated above. I also declare by my signature below that the information I provided is complete and accurate.
Signature of Legal Parent/Guardian
Printed name of Legal Parent/Guardian:
Parent's DL/ID Number:
SECURE YOUR SPOT TODAY!
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Deposit
To secure your spot for a class, you must pay the non-refundable registration fee to complete the process. If the payment is not made, the student will not be registered for an upcoming class. All remaining balances must be paid in full at least four days before the first day of class. We will send a reminder text before the payment date. **ALL online registration fees are $50 + a processing fee of $5.00 **

$55.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

KEYS 4 SAFE DRIVING REGISTRATION FORM

STUDENT INFORMATION

CONTACT PHONE NUMBERS

PARENTAL/GUARDIAN CONSENT- TO BE COMPLETED IF STUDENT IS A MINOR

SECURE YOUR SPOT TODAY! *

Payment Methods

SECURE YOUR SPOT TODAY!