Online Signup

Dear student please complete steps 1 through 3 to signup for a classroom and have your seat reserved. Our web site is updated Real-Time so to assure accuracy of the information. Please make sure to include your email address because your enrollment confirmation will be sent there.
Package NamePackage DescriptionPriceSelect
Segment One SEGMENT ONE CLASS/6 Hours Behind The Wheel/4 hours of observation $375.00

 
Student Information
First Name:  * Student Cell Phone: *
Middle Name: *
If you don't have middle name please enter: NA
Wear Glasses/Contacts:
Last Name:  *   How Did You Hear About Us:
Address:  * Gender:
City:  * High School:
State and Zip:    * License#:
Date Of Birth:      * Student Medication:
Student Email: * Medical/Physical Conditions:
Home Phone: * Fainting / Blackout / Seizure:
 
 
* - Required  
 
  Please call 616-866-8520 with credit card information or bring your credit card on the first day of class.  
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