Registration Step 1 of 5 20% Which class would you like to enroll in?(Required) Skowhegan - March/April - Starts March 18, 2024 How would you like to register?(Required) Non-refundable deposit ($200) Pay in Full ($575) The entire registration fee including any balance due is payable in full before the final class and written exam. Student InformationStudent's Legal Name(Required) First Middle Last Student's Address(Required) Street Address / P.O. Box City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student's Email(Required) Student's Phone(Required)Hair Color(Required) Eye Color(Required) Height(Required) Weight (lbs.)(Required) Student's Date of Birth(Required)It is understood that if the student is not 15 years old by the first day of class they will not be able to continue and will have to wait until the next class after they turn 15, if a seat is available. Month Day Year Please Upload Proof of Student's Date of Birth(Required)Proof of age is required to enroll. Acceptable documents include birth certificate, passport or other legal document showing date of birth. Drop files here or Select files Accepted file types: jpg, pdf, Max. file size: 10 MB. Medical InformationDoes the student have any serious medical conditions that could affect their ability to drive?(Required)Serious medical conditions include Epilepsy/Seizures, Diabetes, Heart Trouble, Blackouts/Loss of Conciousness, Limb Amputation, Paralysis, Stroke/Shock, Parkinson's Disease, Mental/Emotional Issues * Yes No Which medical conditions apply? (select all that apply)(Required) Epilepsy/Seizures Diabetes Heart Trouble Blackouts/Loss of Consciousness Limb Amputation Paralysis Stroke/Shock Parkinson's Disease Mental/Emotional Other (please explain) If you selected any from above, please explain. Parent / Guardian InformationParent / Guardian Name(Required) First Last Parent / Guardian Address(Required) Street Address / P.O. Box City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent / Guardian Email(Required) Parent / Guardian Phone(Required) By signing below both the Student and the Parent / Guardian agree that the information provided in this application is true and correct and that they both agree to all course rules and policies.Student Signature(Required)Parent / Guardian Signature(Required)By clicking "Submit" below, your information will be sent to us. You will be redirected to our Stripe payment gateway for checkout and payment processing. Your registration will not be considered complete or processed unless you enter payment information.CAPTCHANameThis field is for validation purposes and should be left unchanged.
