We need the Drivers license number of the parent which will be attending the parent orientation
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Home Phone Number *
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Parent's Cell Phone NUmber *
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Students Cell Phone Number *
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1. Does the student have any medical conditions that would pose a concern with the student’s behind-the-wheel instruction (epilepsy, asthma, color blindness, hearing loss, etc.)? *
2. Does the student have any mental or physical impairment which could affect his/her ability to drive a motor vehicle safely? *
3. Has the student experienced unconsciousness other than normal sleep? *
4. Is the student’s visual acuity at least 20/40 corrected? *
5. Does the student require any special accommodations to participate in this course (i.e., oral tests, interpreter, seating arrangements, adaptive equipment)? *
Describe locations where the student has driving experience. Check the appropriate box(es) *
Required
Email Address for parent *
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Email Address for Teen *
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A copy of your responses will be emailed to the address you provided.