PLEASE PRINT CLEARLY AND USE YOUR FULL LEGAL NAME
A COPY OF LEARNERS PERMIT OR COPY OF BIRTH CERTIFICATE MUST BE RETURNED WITH ENROLLMENT FORM
LAST NAME__________________________________FIRST_____________________M.I._________
PERMIT #__________________________DATE ISSUED________________D.O.B________________
ADDRESS____________________________________________TOWN_________________________
MAILING ADDRESS___________________________________________TOWN_________________
HOME PHONE_______________________STUDENT CELL#_________________________________
PARENT CELL # ______________________E-MAIL ADDRESS_______________________________
WHAT HIGH SCHOOL DO YOU ATTEND? _______________________________________________
ENROLLMENT IS PROCESSED WITH A NON-REFUNDABLE PAYMENT $250.00
COURSE MONTH_____________________DATES______________________LOCATION___________
DATE PAID____________AMOUNT_________CHECK #________CASH___MONEY ORDER______
BY MY SIGNATURE BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL THE INFORMATION LISTED ON "Nuts and Bolts" and will be at least 15yrs 9months old (TO THE DAY)by class start date.
PRINT PARENT NAME___________________________________________
PARENT SIGNATURE_____________________________________________DATE________________
STUDENT SIGNATURE____________________________________________DATE________________
NAME OF PARENT ATTENDING 2-HOUR PARENT CLASS__________________________________
DATE OF PARENT CLASS CHOSEN_____________________________________________
Grand Prix Driving School