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2022 HMS Summer Driver's Education Registration
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Email Address of Student:
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Student's First Name:
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Student's Middle Name:
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Student's Last Name:
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Student's Cell Phone Number:
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Address:
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City, State, and Zip:
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Grade:
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Student's Age:
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Student's Date of Birth:
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Does the student have a learner's permit?
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Date the learner's permit was issued:
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Date the learner's permit will expire:
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Parent/Guardian Name
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Parent/Guardian Phone Number:
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Parent/Guardian Email:
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