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	Information about the student taking the course: (* indicates required field)
	1) *Choose your driving school from the list. (Required)
	2) *Enter the agreement/contract number you received from your driving school.
	3) *Zip Code. (System will lookup city and state.)
	4) *Student’s house number and street name.
	5) *Apartment Number (if you have one)
	6) *Student’s Phone Number
	7) *Student’s legal first name.
	8) Student’s legal middle name. (Use NMN if none.)
	9) *Student’s legal last name.
	10) *Student’s Date of Birth ( ex. 01/01/2019)
	11) *First and last name of parent or legal guardian.
	12) *Parent or guardian’s phone number.
	13) *Student’s valid Email Address. (Each student must use a different email address.)
	14) Parent or guardian’s valid email address.
	15) *Enter the price you paid for this course. (numbers only ex. 125.00)
	16) *Choose the type of course you are taking.

Please check that all information entered above is correct. If not, please correct before clicking on the SUBMIT button. If the information is correct, please click on the SUBMIT button below. When you click on the SUBMIT button, the message (Your information has been inserted into the program database. Please close your browser window to exit this page.) will appear in the message box if the registration form was filled out and submitted correctly. If the form is missing required information, you will receive an error message in the message box. Correct information and then click on the SUBMIT button.

To exit this registration page, please close your browser window.