July 22ND to July 29TH Driver Ed Registration - (Dates/time subject to change) Location - Holden Training Room at Holden PD from 9 AM to 1 PM - Notes - Please double check spelling and email addresses for correct format - Do not add extra information in answer fields I.e. If there is only one parent, leave the 2nd parent's info blank. Print Confirmation when done and return a copy with your check made out to WRSD. *Please note student name and class date in the memo

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Student Registration and Information

Email *

By signing you understand that all payments and balances are due two weeks prior to class. Full cost is $800.00. Checks should be made out to WRSD. Please remember to print your confirmation as the system does not mail receipts. Parent/Guardian names will be on the parent class list. Please include a note with students name and date of class with all money orders and bank checks. *

If you have any additional information, or questions please note it here.

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 - (If none, please leave this line blank)

Parent 2 cell #

Is your parent taking our Parent/Guardian Class? *

Yes

No, they already took one in the past five years

Required

If parent already took the parent class - please supply the school name, date of class attended, name of the parent who signed in and the student you were taking it for - Note - If taken at a different driving school, you will need to email me copy of a parent class certificate within ten days.

Learners Permit Number if you already have one.

Issue date of your Permit

YYYY

Amount you are mailing today. Total cost is $800.00 -Payable in two payments - (the minimum amount is $400) the remaining balance is due 2 weeks prior to class date. There is currently no credit card option. *

Check or Money Order Number - (Please note Student name and class date on memo)

Special needs, disabilities and or medications that you feel we should know about *

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

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of WRSD. Report Abuse

Forms