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 * December 17th, 2023 January 7, 2024 January 21, 2024 February 4, 2024 February 18, 2024 March 3, 2024 March 17, 2024 April 7, 2024 April 21, 2024 May 5, 2024 May 19, 2024 June 2, 2024 June 16, 2024 July 7, 2024 July 21, 2024 August 4, 2024 August 18, 2024 September 1, 2024 September 15, 2024 October 6, 2024 October 20, 2024 November 3, 2024 November 17, 2024 December 1, 2024 December 15, 2024 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.