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Holman's Driving School
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Web Page Questions
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Use the following form to sign up.
Parent or Guardian
*
Do you have an email address?
*
Yes
No
Email (We will use this to send you a copy of the registration for class)
*
Son/Daughter ( If Adult Please Just type Adult )
*
As it appears on Permit
Payment Method
*
Cash
Personal Check
Credit Card Online
PayPal
Class Choice
*
In Class Instruction ( 8 Hours )
Behind the Wheel ( 6 Hours )
In Class Instruction and Behind the Wheel
Road Test
In Class Instruction, Behind the Wheel and Third Party Road Test
Copy Of Certificate
Adult Class Per Hour (Minimum of 6 Hours)
Insurance Discount (Dependent on insurance provider) applies only if you take both Classroom and Behind the Wheel Classes.
Class Date Choice
*
October 3, 2021
October 17, 2021
October 31, 2021
November 7, 2021
November 21, 2021
December 5, 2021
December 19, 2021
January 2, 2022
January 16, 2022
February 6, 2022
February 20, 2022
March 6, 2022
March 20, 2022
April 3, 2022
April 17, 2022
May 1, 2022
May 15, 2022
June 5, 2022
June 19, 2022
July 3, 2022
July 17, 2022
August 7, 2022
August 21, 2022
September 4, 2022
September 18, 2022
October 2, 2022
October 16, 2022
November 6, 2022
November 20, 2022
December 4, 2022
December 18, 2022
Student Name
*
As Appears on Permit
Date of Birth
*
Permit or License Number
*
Issue Date
*
Student Address
*
Student Phone Number
*
Cell Phone Number
If no cell number is available please put N/A in this field.
Car
*
Students will be driving a Ford Taurus, Ford Focus, Ford Fiesta or a Toyota Scion that is automatic and has a instructor brake on the passenger side.
Student Signature
*
By placing your name in this text box you understand that this is your binding signature.
Parent/Guardian Signature
*
By placing your name in this text box you understand that this is your binding signature.
If you are human, leave this field blank.