Beginning/Teen Driver

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Beginning Driver Class Registration Form

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Student Full Name: *

Parent Name (if <18):

Home Address: *

Parent Telephone:

Student Telephone: *

Student Date of Birth *

Student Age *

Permit Number *

Permit Issued Date *

Grade and School

Class Date Requested *

EMail Address *

Current Hours of Practice / Availability for Lessons *

Captcha (spam protection code) *

I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. Lexington Driving Academy does not guarantee a student will pass the driving test and obtain a license. Driving instruction will be in our vehicles equipped with automatic transmission and instructor brakes. There will be a $50.00 cancellation fee for lessons cancelled with less than a 24 hour notice. There will be a $35 fee for any returned checks.

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