Registration Form
Step 1 of 3: Submit
Driver's Education - ONLINE Class
Student Information
Student First Name
*
Student Middle Name
Student Last Name
*
Date of Birth
*
Phone Number
*
Student Email
Learner's Permit Date of Issue
Learner's Permit Number
Learner's Permit
Remove
Remove uploaded file
Parent/Guardian Information
Parent/Guardian Full Name
*
Parent/Guardian Email
*
Street Address
*
City
*
Zip Code
*
Online - Driving Class (by Month)
September 2021 (Online Class)
Choose a class
September 20 - October 5, 2021 (M-Th 5:30pm - 8:30pm)
October 2021 - (Online Class)
October 11 - 26, 2021 (M-Th 5:30pm - 8:30pm)
October 18 - 29, 2021 (M-F 4:00pm - 7:00pm)
November 2021 (Online Class)
November 1 - 16, 2021 (M-TH 5:30pm - 8:30pm)
November 8 - 19, 2021 (M-F 4:00pm - 7:00pm)
December 2021 (Online Class)
November 29 - December 14, 2021 (M-TH 5:30pm - 8:30pm)
December 6 - 17, 2021 (M-F 4:00pm - 7:00pm)
Payment
Please choose a payment option.
*
Select an option:
Pay Deposit now and pay remainder later ($25 USD)
Pay in Full - ($320 USD)
Question? Contact Us
Office@chesapeakeDS.com
Pop out
Full screen
I have been provided a copy of CDS policy and procedure.
*
Date:
Friday, 24 September 2021 (EDT)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Pop out
Full screen
I understand the rights and responsibilities of driving schools, students, parent/driver coach.
*
Date:
Friday, 24 September 2021 (EDT)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
*
indicates required fields