Registration Form

New Driver Education

Student First Name * Student Last Name * Date of Birth (Student) * Parent/Guardian First Name * Parent/Guardian Last Name * Parent/Guardian Email * Phone Number (Format: xxx-xxx-xxxx) * Address * City *

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Select Your Driving Class Date

Patuxent High School * Select an option:Choose a class dateSeptember 9 - 20, 2019October 21 - November 1, 2019December 2 - 13, 2019

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Payment Options

Payment Options (You must choose one) *

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