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Driver Education Program 2021-22 Student Application for Prairie South School Division
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* Indicates required question
School Name
*
Central Collegiate
Peacock
Riverview
What in-class session would you like to register for?
*
After School
Lunch hour
SGI Customer Number
*
Students will not be accepted into a class without this number. Students MUST obtain an SGI Customer Number from SGI and set up an MYSGI account in order to be accepted into the Driver Education Program.
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
Your date of birth must be in the following format: Month/Day/Year. Other formats will not be accepted.
MM
/
DD
/
YYYY
Student Email Address
*
Your answer
Alternate Email Address
Your answer
Student Phone Number
*
Your answer
Parent/Guardian's Name
Your answer
Parent/Guardian's Cell Phone Number(s)
*
Your answer
Home Phone Number
Your answer
Home Address
*
Your answer
City
*
Your answer
Postal Code
*
Your answer
Please identify any allergies and/or medical concerns.
*
Enter N/A if this question doesn't apply to you.
Your answer
Have you taken Driver Education classes before?
*
Yes
No
If yes, indicate how many hours in-class and in-car you completed.
Your answer
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