STUDENT REGISTRATION |
| * marked fileds are mandotary. |
| First name*Please type it
as is show on your birth certificate |
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| Middle name Required
if any |
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| Last name* |
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Gender
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Male
Female |
| Card Holder Name |
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| Best phone to contact you* |
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| Phone 2 optional |
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| Cellphone |
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| Parent Phone |
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| Home address* to be pick up
at home for your car training |
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| Apartment or complex name |
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| Apartmant number |
Do you live in a Community Gate? Yes No
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| City* |
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| Zip Code* |
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| Major cross streets |
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Appoinment's pickup address if different from home address
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| High school name |
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| Where did you hear about us? |
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| Date of birth * |
(mm-dd-yyyy)
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Comments Please
type any other information you might consider useful for
us.
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Permit or license number if
any
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Yes
No
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| Issue date |
(mm-dd-yyyy)
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| Expiration date |
(mm-dd-yyyy)
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Enter
your Account information |
Username * |
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| Password * |
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| Email* |
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| Confirm Email* |
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