STUDENT REGISTRATION

Parent Name

Student Name

Steet Address

City

Zip Code

Phone Number

Email Address

Learners Permit No

Learners Permit Issue Date

Student Date of Birth

Amount[Courses]

Credit Card Number

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Expiration Date

CVV Number

Signature

( Enter your Fullname )

Parental Consent, Rates & Policies *

By checking this box, I give my son/daughter my parental consent to attend Glastonbury Driving School and that I have read the Policies & Rates.

I GIVE MY SON/DAUGHTER PERMISSION TO DRIVE WITH GLASTONBURY DRIVING SCHOOL. I ACKNOWLEDGE THAT MY SON/DAUGHTER MAY BE DROPPED OFF BY PRIOR STUDENT FROM LESSON DEPENDING ON THE TIME.

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