Allen Enrollment - Driving School of North Texas

Student Information

Legal First Name*

Parents Email*

Enter Email Confirm Email

Middle Initial*

Students Cell*

Legal Last Name*

Parents Cell*

High School*

XXXX

Birthday*

Other Phone

Sex*

Male
Female

Address*

Street Address City State ZIP Code

Fees & Services

Services

Driver Education Class (24 hrs Class & 7 driving lessons)
2 Driving Lessons-Must be paid in full at time of enrollment

Other Services

Drivers Education Classroom Instruction Only
7 Driving Lessons-Must be paid in full at time of enrollment

Total

Class Enrollment

This form is for enrollment at the Allen Location only

Start Date*

Start Time*

:

Selecting Start Date: For classroom students, select start date and time from our class schedule. For Driving Lesson students select today's date and time. You will receive an email with your user name and password to schedule driving lessons. School may terminate Student’s enrollment if Student accumulates absences in excess of 5 days of scheduled classroom hours. Driver Permit may be revoked if classroom is not completed within two hundred ( 240) days. The Parent and Student agree that all classroom and in-car lessons must be made-up/completed within the 240 days of the classroom beginning date.

Initials*

I agree to the terms and Conditions*

Yes
No

Signature*

Signature of School Representative

Disclosure

Medical Condition*

Does your student currently have or had ever been diagnosed with or treated for any medical condition that may affect his/her ability to safely operate a motor vehicle?

Hospitilization*

Within the past two years, has your student been diagnosed with, been hospitalized for or currently being treated for a psychiatric disorder? Examples included but not limited to ADHD, ADD, epileptic seizure, convulsion, loss of consciousness or other seizure.

If Yes, please explain

Payment Details

Pay*

Now
Later

Card Number

Payment Form

Expiration Date

Security Code

This form is for enrollment at the Allen Location only

Post Custom Field