Student Registration Form

SELECT REASON FOR CLASS

SELECT : TICKET DISMISSAL (OTHER) $95.00
SELECT : INSURANCE DISCOUNT (O.C.G.A. §33-9-42) $95.00
SELECT : POINTS REDUCTION – (O.C.G.A. §40-5-86) $95.00
SELECT : STATE LICENSE REINSTATEMENT $95.00

and Disclosure Photo

Full Legal Name

First

Middle

Last

Driver’s License No.

Please enter your full driver’s license number exactly as it appears on your license. This information is required for identity verification, course record maintenance, and certification reporting purposes.

ID Document Photo Capture Required

Please use your device’s camera to capture a clear photo of your valid drivers license. Make sure the entire ID is visible, well lit, and free of glare or blur. This is required to verify your identity and complete the form.

Date of Birth (MM/DD/YYYY)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please enter your residential address exactly as it appears on your driver’s license.

Phone Number

Email Address

Acknowledgment of Policies and Agreements

By checking this box, I confirm that I have read and agree to the Privacy Policy, Terms of Service / User Agreement, Refund & Reschedule Policy, Payment Policy, E-Signature Consent Disclosure, and Accessibility Policy (available in the website footer). I understand that agreeing to these policies is required for enrollment and participation, and that they govern my registration, attendance, payments, and related services. I acknowledge that checking this box serves as my electronic signature and creates a legally binding agreement under applicable Georgia and federal law, including the E-SIGN Act.

E-Signature Consent and Disclosure

Clear Signature

By signing above, I acknowledge that my electronic signature is legally binding under applicable Georgia law and the federal E-SIGN Act. I consent to Georgia GoDrive Traffic School LLC. contacting me by phone, email, SMS/text message, or other means regarding my enrollment, course requirements, and related matters, and understand such communications may be saved for quality assurance, training, and documentation. (Message and data rates may apply. Reply STOP to opt out of texts.) I agree to complete and electronically sign the Student Contract required before attending class and understand my registration is not final until it is completed. I acknowledge that failure to complete the contract before the scheduled class may result in cancellation of enrollment, forfeiture of my seat, and loss of applicable fees in accordance with DDS requirements and clinic policy.