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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 *

License / 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

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Password *

Confirm Password *

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

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B.T.W. Parent Assist-2 lesson Package

Currently no courses providing this service are available for registration

B.T.W. Instruction-6 lesson Package

Currently no courses providing this service are available for registration

2022 - 2022 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

Currently no courses providing this service are available for registration

2022 - Fall Session
September 12 - October 3
We will have two in-person sessions on September 12th and October 3rd from 6:00-7:30 pm. The online portion of the course will be asynchronous where students will complete lessons and activities on Canvas. Online class information will be emailed to students when payment is made. Driving times are available starting on August 29th All class assignments and activities will need to be finished by October 31st. Students will schedule six hours of driving with the driving instructors listed.

Private Lesson

Currently no courses providing this service are available for registration

2022 - Adult Private Lesson
Private Adult Lessons are available. Cost is $100.00 for 90 minutes of instruction. Mr. Rolwes has limited availability to conduct these lessons at this time. DO NOT REGISTER for these lessons without contacting him first at 319-573-6378

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Register a New Student

Student Information

License / Permit Information

Primary Address

Secondary Address

Parent (Guardian) #1 (Optional)

Parent (Guardian) #2 (Optional)

Account Information

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