Teen Driver's Education Registration
Acceptance of ONLINE
Refund/Cancellation policy
Type full initials of submitting individual
LEGAL First Name:
LEGAL Middle Name:
LEGAL Last Name:
Home Address:
City:
County:
Zip:
Home Phone:
Student's Cell Phone:
Student's Email:
Parent/Guardian's Names:
Mom's Cell Phone:
Mom's Email:
Mom's Workplace:
Mom's Work Phone:
Mom's DL#:
Dad's Cell Phone:
Dad's Email:
Dad's Workplace:
Dad's Work Phone:
Dad's DL#:
~ Student Information for License Application ~
Birthdate mm/dd/yyyy:
Age Now:
 Gender:
Birth Place STATE:  
Birth Place CITY:  
Ethnicity:
Birth Place Country:  
Eye Color:
 Hair Color:
Texas ID #
Weight:
Vision:
 Height:
Color Blind?
Grade level:
School Attending:
~ Student Medical and Instructional Needs ~
Describe Any Instructional (IEP-special ed)  
or Medical (existing conditions) Needs:
Physician:
Physician's Phone:
Known Allergies:
Hospital Preference:
LOCAL Emergency Contact-other than parents listed above
(include Name and Number):
~ Course Registration Information ~
Dates of Class:
Times of Class:
** I will make my course tuition deposit by:
** NO REGISTRATION IS COMPLETE WITHOUT DEPOSIT PAYMENT, AND RECORDS SUBMISSION.  YOUR
SPOT MAY BE FILLED BY SOMEONE ELSE IF YOU FAIL TO COMPLETE YOUR  REGISTRATION.

    **By submitting this registration form, your spot in the class will be held, but will not be officially
    secured until a minimum deposit payment ($75) has been received by the school.  Please
    proceed to the "PAY ONLINE" page of this website to complete your registration process.

    **ALSO, all other required enrollment forms MUST be presented to the school prior to first hour
    of the first course day:  
    1) Official State Birth Certificate
    2) Official Social Security Card, signed by student
    3) Verification of Enrollment form, obtained from the public school attendance registrar.   
    4) Signatures by parent/guardian and student on DTC contract, and DPS license application.