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Student Information

Legal First Name *		Legal Middle Name *		Legal Last Name *

Nickname / Preferred Name

Email Address *

Home Phone *		Cell Phone

Birth Date (mm/dd/yyyy) *
	/		/

Sex *

Permit Information

Number
Issuance Date
Expiration Date

Primary Address

Address *

City *		State *		Zip *

Secondary Address

Address *

City *		State *		Zip *

Parent (Guardian) #1 (Optional)

First and Last Name *		Email Address *

Home Phone *		Work Phone *		Work Extension

Cell Phone *

Parent (Guardian) #2 (Optional)

First and Last Name		Email Address

Home Phone *		Work Phone *		Work Extension

Cell Phone *

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Account Information

Username *

Password *

Confirm Password *

Password policy: 8 character minimum, having any combination of alphabetic, numeric, and symbolic characters.

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Behind the Wheel Instruction

There are currently no courses available for registration for this service.

2021 - 2019-2020 Driving Instruction
Students may sign up for driving lessons when the schedule is complete and they have paid the $200 deposit or made full payment

Classroom Instruction

There are currently no courses available for registration for this service.

2021 - Spring II Course
April 5 - May 10
Class to be held virtually on April 5th and May 10th from 6:00-8:00pm. The rest of the online course will be completed independently by students. The online course must be completed by May 28th.

Private Lesson

There are currently no courses available for registration for this service.

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Register a New Student

Student Information

Permit Information

Primary Address

Secondary Address

Parent (Guardian) #1 (Optional)

Parent (Guardian) #2 (Optional)

Account Information

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