Drivers Ed Registration Get Registered for Driver’s Education Drivers Ed - September/October Parent Meeting: September 22 Classroom portion: September 26-October 21 - 3:45pm-6:20pm Driving schedule will be determined during the classroom portion. "*" indicates required fields Student Name* First Last Student Cell Phone Number* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Date of Birth (must turn 14 by October 21, 2022)* MM slash DD slash YYYY Grade for the 2022/2023 School Year Is there anything you would like to share with the instructor about your child? (i.e. very shy, learning disability, etc.) Parent 1/Legal Guardian Name* First Last Parent Email* Parent 1 Cell Phone*Parent 2/Legal Guardian Name First Last Parent/Guardian Email Parent/Guardian 2 Cell PhoneDriver's Ed Fall 2022 Course Price: Parent/Legal Guardian Consent*By submitting this form, I certify that I am the parent/legal guardian of the student and give permission for my student to participate in all portions of the program. The student is not currently using any medications that induce drowsiness or otherwise cause impairment. The student does not suffer from any condition (such as epilepsy or severe visual or hearing impairment) which would make participation in the program unreasonably dangerous to the student or to others, and the student will wear (if needed) any eyewear or hearing apparatus required to operate a motor vehicle safely. The student will not have used alcohol or any drug in the 24 hours preceding participation in the program. I understand that although the program is intended to improve driver skills and that CCC will take reasonable safety precautions, there are both known and unanticipated risks which could result in severe personal injury, death, or property damage, as well as liability for myself and the student relating to the student's operation of a vehicle. I release, waive, and indemnify CCC from and against any and all claims and liabilities. If a collision occurs for which the student is in any way responsible, I understand and agree that I will be responsible for all damages resulting therefrom. Yes, I agree. Total Credit CardCard Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.