THS DEC-1 (Pink) Card Request

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This form is used to request your DEC-1 (Pink) Card to begin Behind the Wheel (BTW) with a company OUTSIDE OF THS. It is legally required to be submitted BEFORE you start BTW instruction. If you are planning on taking BTW at THS you DO NOT need to complete this form.

To schedule BTW with a THS Instructor, please contact Dave.Gryder@LCPS.org.

I want to take BTW at Tuscarora High School. *

Yes - STOP HERE. Your card will be given to the driver when you begin BTW with THS.

No - Please provide card. I am going to an outside company for BTW.

Student ID Number *

Email address *

Last Name (as it appears on your permit) *

First Name (No nicknames) *

Birthdate

Home Address *

Have you attended Partners in Teen Safe Driving (PTSD)? *

Yes

No - If no stop here you are not eligible for your DEC-1 card until you attend.

Where and when did you attend PSTD?

Questions/Concerns

By entering your full legal name in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *

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