Registration Form
Step 1 of 3: Submit
Driver's Education - ONLINE Class
Student Information
Student First Name
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Student Last Name
*
Date of Birth
*
Student Email
Learner's Permit?
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Yes
No
Parent/Guardian Information
Parent/Guardian Full Name
*
Parent/Guardian Email
*
Parent/Guardian Phone Number
*
Address
*
City
*
Zip Code
*
Select Your Driving Class Date
Online Class - Duke Street
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November 2 - 17, 2020 (M-Th 5:30pm-8:30pm)
November 9 - 20, 2020 (M-F 3:30pm - 6:30pm)
December 7 - 18, 2020 (M-Th 5:30pm-8:30pm)
January 4 - 19, 2021(M-Th 5:30pm-8:30pm)
January 18 - 29, 2021 (M-F 4:00pm - 7:00pm)
January 25 - February 9, 2021 (M-Th 5:30pm-8:30pm)
Payment Options
Payment Options (You must choose one)
*
Pay Deposit and receive invoice ($25.00 USD)
Pay in Full ($315 USD)
Question? Contact Us
Office@chesapeakeDS.com
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I have been provided a copy of CDS policy and procedure.
*
Date:
Wednesday, 21 October 2020 (EDT)
Name:
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