TEST 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 Online Class Choice * Written Permit Test 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 * March 19th, 2023 April 2nd, 2023 April 16th, 2023 May 7th, 2023 May 21st, 2023 June 4th, 2023 June 18th, 2023 July 2nd, 2023 July 16th, 2023 August 6th, 2023 August 20th, 2023 September 3rd, 2023 September 17th, 2023 October 1st, 2023 October 15th, 2023 November 5th, 2023 November 19th, 2023 December 3rd, 2023 December 17th, 2023 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. Vehicle Acknowledgement * I acknowledge and understand that students will be driving a Ford Taurus, Ford Focus, Ford Fiesta or a Toyota Scion that is an automatic and has an 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. Captcha If you are human, leave this field blank.