Registration Form
Step 1 of 3: Submit
Driver Education - IN-PERSON (Duke Street Classroom)
Parent/Guardian First Name
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Parent/Guardian Last Name
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Parent/Guardian Email
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Phone Number
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Address
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City
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Student First Name
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Student Last Name
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Date of Birth (Student)
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Select Class Date
Duke Street Classroom
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October 26 - November 6, 2020 (M-F 4:00 pm - 7:00 pm)
November 30 - December 11, 2020 (M-F 4:00 pm - 7:00 pm)
January 4 - 15, 2021 (M-F 4:00 pm - 7:00 pm)
Payment Options
Payment (Please choose an option.)
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Pay Deposit - mail payment to PO Box 3502 Prince Frederick 20678 ($25 USD)
Pay Deposit - receive invoice to pay online ($25 USD)
Pay in Full ($340 USD)
Question? Contact Us
Office@chesapeakeDS.com
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I have read and agree to the terms outlined in Chesapeake Driving School Policy and Procedures.
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Date:
Sunday, 25 October 2020 (EDT)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
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