Due to a high demand for the Teen Driver Challenge course and limited seating (12 per class), two attempts will be made to notify the student / guardian of their class date the week before the class. If the student's attendance is not confirmed, they will be dropped from the class and will need to reapply.

If attendance is confirmed and the student / guardian needs to cancel, they must contact Elizabeth Bingham 72 hours prior to the class date. If you fail to cancel in this time frame, the student will be dropped to the bottom of the waiting list. Students who have been on the waiting list will be given priority for the next class.

Available Classes:
     07/30/2016

Name on Driver's License  
DOB (mm/dd/yyyy format)      
Race
Sex
Driver License Number  
DL State
Address  
City  
State
ZIP  
Mailing Address (if different than above)
City
State
ZIP
Primary Phone Number
(Format ##########)
No hyphens.
 
Cell Phone Number
(Format ##########)
No hyphens.
Current School  
Current Grade  
Contact Email Address  
Parent / Guardian  
Contact Phone  
Contact Email  
Shirt Size
Are you taking any medication(s) that
would affect your ability to operate a vehicle?
Describe if so.
Are there any health issues that
prevent you from participating in the program?
Describe if so.