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Teen Beginner Course Enrollment

Please complete the form as completely as possible to start your enrollment in our school.
Class Date and Program Selection
  • Thursday, June 30th, 2022
  • Thursday, July 14th, 2022
  • Thursday, July 28th, 2022
  • Thursday, August 11th, 2022
  • Saturday, August 27th, 2022
  • Saturday, September 17th, 2022
  • Saturday, October 8th, 2022
  • Saturday, October 22nd, 2022
  • Saturday, November 5th, 2022
  • Saturday, November 19th, 2022
  • Saturday, December 3rd, 2022
  • Saturday, December 17th, 2022
  • Wednesday, December 28th, 2022
  • Beginner Basic Course (8Hr Class / 6Hr Driving) - $475.00
  • Beginner Plus Course (8Hr Class / 8Hr Driving) - $599.00
  • Beginner Premium Course (8Hr Class / 10Hr Driving) - $699.00

Student Information
  • Male
  • Female

Guardian Information

Living With

Student Medical Information

Does the student wear glasses / contacts?

Does The Student Have Any Impairment That Would Prevent Him / Her From Receiving And Applying Verbal Instruction / Direction ? If So, Please Explain:

Are There Any Conditions That We Should Know About That Could Affect A Student's Driving Capability Physically?

Does The Student Take Any Medication? If So, What Kind & What Is It For? (Please List All)

Please Let Us Know If The Student Has Ever Been Diagnosed With Any Of The Following: (Check all that apply)

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