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HHS Jun 2022 Drivers Ed Class
Please fill out this form if you are interested in signing up for the Jun 6 - Jun 14 Driver Education Course Online. Please make sure that you are 14 ½ years old. You must have been born on or before 12/6/2007.
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* Indicates required question
Email
*
Your email
Student First Name
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Your answer
Student Middle Name
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Your answer
Student Last Name
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Your answer
Student Home Address ex. 123 Chestnut Drive
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Your answer
Student City ex. Havelock
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Your answer
Student Zip code ex. 28532
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Your answer
Student Birth date (You must be 14 ½ Years old birth date on or before 12/6/2007)
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MM
/
DD
/
YYYY
What school does the student attend?
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Havelock High School
Early College East
New Bern High School
Gramercy Christian School
Ephiphany School of Global Studies
Other:
What grade is the student currently in?
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8th
9th
10th
11th
12th
Student Home Phone number ex. 123-456-7890
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Your answer
Student Cell Phone number ex. 123-456-7890
Your answer
Parent/Guardian #1 Home/Cell Phone number
Your answer
Parent/Guardian #2 Home/Cell Phone number
Your answer
Student School Email Address:
*
Your answer
Student Personal Email Address:
Your answer
Parent/Guardian #1 Email address
Your answer
Parent/Guardian #2 Email address
Your answer
A copy of your responses will be emailed to the address you provided.
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