Registration Form
Step 1 of 3: Submit
Please complete and 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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Zip Code
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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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Duke Street Classroom
In Person Class - Duke Street
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Select an option:
March 1 - 12, 2021 (M-F 4:00pm - 7:00pm)
Payment Options
Payment (Please choose an option.)
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Pay Deposit - receive invoice for balance due ($25 USD)
Pay in Full ($340 USD)
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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:
Tuesday, 19 January 2021 (EST)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Question? Contact Us
Office@chesapeakeDS.com
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