ENROLL Drivers Ed Driving Only

PARENT 2 EMAIL ADDRESS

ENROLLMENT FORM

6 Hours of Driving for

NC Learner's Permit

or For

Additional Practice

Tuition is $395. A $200 non-refundable deposit is due upon enrollment. The balance is due 1 week before the 1st lesson.

PARENT 1 PHONE NUMBER *

STUDENT'S EMAIL ADDRESS

PARENT 1 EMAIL ADDRESS *

STUDENT'S DATE OF BIRTH *

STUDENT ADDRESS *

IF YOU ARE UNABLE TO SUBMIT THIS PAGE, PLEASE BE SURE YOU HAVE FILLED-IN ALL REQUIRED FIELDS. QUESTIONS / COMMENTS BELOW

PARENT 2 PHONE NUMBER

ZIP *

STUDENT'S SCHOOL

NAME OF PARENT 1 *

DID STUDENT HAVE VISION TESTED BY THE CLASSROOM PROVIDER?

HOW DID YOU HEAR ABOUT US?

CITY *

FULL NAME AS APPEARS ON BIRTH CERTIFICATE *

6 Hours Driving - $395 / $200 Deposit Collected After Enrolling

WHERE DID STUDENT TAKE CLASSROOM PORTION OF DRIVERS ED?

STUDENT PHONE NUMBER

NAME OF PARENT 2