Please fill out this student registration form before class.

Step 2 of 2

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COMPLETE YOUR STUDENT REGISTRATION FORM

Please provide details as they appear on your Driver’s License. This ensures your completion is accurately reported to the Georgia Department of Driver Services (DDS).

REASON Card Seat

SELECT REASON FOR CLASS

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

Choose Avalible Course

Full Legal Name

First

Middle

Last

ID Document (if applicable)

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. We use this information to accurately report your completion to the Georgia Department of Driver Services.

Phone Number

Email Address

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 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.

Single Seat

Price: $95.00

Credit/Debit Card

Complete Booking

Step 2 of 2

COMPLETE YOUR STUDENT REGISTRATION FORM

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