Registration Form
Step 1 of 3: Submit
Please complete and submit.
Driver Education - IN-PERSON (Duke Street Classroom)
Student First Name
*
Student Last Name
*
Student Email
*
Date of Birth (Student)
*
Phone Number
*
Address
*
City
*
Zip Code
*
Parent/Guardian Last Name
*
Parent/Guardian Email
*
In-Person Driver Education Class
Duke Street Classroom
*
Select an option:
September 6 - 17, 2021 (M-F 5:00pm - 8:00pm)
October 4 - 15, 2021 (M-F 5:00pm - 8:00pm)
November 1 - 12, 2021 (M-F 5:00pm - 8:00pm)
November 29 - December 10, 2021 (M-F 5:00pm - 8:00pm)
Tuition
Choose a payment option:
*
Select an option:
Pay Deposit - receive invoice for balance due ($25 USD)
Pay in Full - ($360 USD)
Pop out
Full screen
I have read and agree to the terms outlined in Chesapeake Driving School Policy and Procedures.
*
Date:
Friday, 24 September 2021 (EDT)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Question? Contact Us
Office@chesapeakeDS.com
*
indicates required fields