Course Registration Form

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Please complete the registration form to continue.

Segment 2 Input Form

Virtual Class

Feb 16 - Feb 19

Tuesday, Wednesday, Thursday

4:00 pm - 6:00 pm

---- You must meet State Qualifications to register for this class
Have Level 1 Learner’s License (permit) for at least 3 months(consecutively). Completed at least 30 hours of practice driving 2 hours of night time driving with your parent, guardian, or approved licensed driver who is at least 21. ----

Student Section

Student Phone Type *

Parent/Guardian Section

---- Please complete the section ONLY if the student is under the age of 18 ----
Phone Type
---- Before submitting, please double check to make sure that all of the information is correct -----