Registration Form
Step 1 of 3: Submit
New Driver Education
Student First Name
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Student Last Name
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Date of Birth (Student)
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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 (Format: xxx-xxx-xxxx)
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Address
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City
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Select Your Driving Class Date
Patuxent High School
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Select an option:
Choose a class date
January 6 - 17
February 3 - 14
March 9 - 20
April 15 - 17, 20 - 24, 27, 30
May 11 - 22
Payment Options
Payment Options (You must choose one)
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Pay Deposit ($25 USD)
Pay in Full ($350 USD)
Pay by Check - (Payments may be mailed to: P.O. Box 3502 Prince Frederick, MD 20678)
Question? Contact Us
Office@chesapeakeDS.com
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