Driver’s Education:
Registration for Online-Only Class

1. Read the Cancellation/Refund Policy.

2. Fill out the form below.

   Registration: Online Only
   Student Name: (Legal first, middle, and last names) No nicknames, please.	First: Middle: Last:
   Student's Address:	Address: City: State: Zip:
   Student's Date of Birth:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919
   Student's Home Phone:
   Student's Cell Phone:
   Student's Email:
   I am:	In Junior High School In High School In College/University No Longer in School Name of school, if applicable
   Parent/Guardian Name:	First: Last:
   Parent/Guardian Email:
   How did you hear about our school?	Internet Newspaper Flyer Used our School Parent Pages School (which school?) Phone Book (which phone book?) Personal Referral (who, so we can thank them?) Other (please specify)
   I have read, and agree to abide by, the Cancellation/Refund Policy.
   I understand that all students must present a photo ID and permit preregistration number on the first day of class to take a permit test. (See mydmv.colorado.gov and choose Apply for a Driver License or ID).

3. Once you have filled out the form above, you will receive confirmation and further instructions by email within a few days.