September 8th - 28th 2021 Class Registration Form

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Student Registration and Information

Email *

Last Name *

First Name *

Middle Name *

Street Address *

City *

Zip Code *

Date of Birth eg, 01-31-04 *

Student's WRHS email address *

Student Cell # *

Parent 1 name *

Parent 1 email address *

Parent 1 Cell # *

Parent 2 name *

Parent 2 email address *

Parent 2 cell #

Is your parent taking our Parent/Guardian Class? *

Yes

No, they already took one in the past five years -

Required

If your parent took the parent class already please supply the school name and date of class attended

Learners Permit Number if you already have one.

Issue date of your Permit

YYYY

Amount you are mailing today (min amount $400) *

Check or Money Order Number

Medical conditions/Special needs or medications we should be aware of *

I understand that classes will be held in the classroom starting in September. I also understand that the RMV is doing road tests using their own MASS DOT vehicles. Also upon completion of driver ed; it may take a week or so for all records to be uploaded by the RMV before any road tests can be booked. *

Got It!

I still have questions, I will email you later

A copy of your responses will be emailed to the address you provided.

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