Teen On-Line - 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

Services

"The Online Bundle" - (32 hour Online class & 14 hours driving lessons) = $479.00. The Parent and Student agree that all online modules and in-car lessons must be completed within the 240 days of registering.

Select Location*

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

Card Number*

Payment Form*

Expiration Date*

Security Code*

I accept the Terms and Conditions*

I Agree

Signature*

Learn More

Your User ID and Password will be emailed to you within 24 hours of enrollment Sunday thru Thursday. Enrollments that occur Friday and Saturday User ID & PW will be emailed by close of business the following Monday

Teen On-Line Enrollment

Student Information

Services

Disclosure

Payment Details