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Driver Education Behind the Wheel Registration
Online Registration Now Available
____________________________________________________________
First Name Middle Name Last Name
______/______/___________ Current Age ______
Date of Birth
_________ _________________________________________
Grade in School School Attending
______________________ ______________ _______ ________
Address City State Zip
_______________________________ ___________________________
Parent/Guardian Name Parent/Guardian Email
_____________________________________
MN Instruction Permit Number
Please have the Behind the Wheel Instructor contact me at:
Parent Cell ____________________ Student Cell __________________
Home Phone ___________________ Email ________________________
Behind the Wheel takes place outside of the school day. I am available:
(Circle all that apply) After School Weekday evenings Sat a.m.
Payment of $257 included with this registration:
______ Cash Check # __________ (payable to Community Education)
VISA/MasterCard/Discover _____________________________________
Exp Date __________ Name on card ____________________________
*There is a $10 fee for replacement white cards and a $30 fee for class cancellation or dropped driving appointments.
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