Young Driver Risk Reduction Course
 Registration Form

 

Requested Course Date: First Choice: ___________Second Choice:_________________
 

A letter will be sent confirming your enrollment in the class of your choice. 
Please do not assume you are enrolled in a class unless you receive a confirmation letter.

Name:___________________________________________
                  Last                                    First                              MI    

Home Address:_____________________________________

City, State & Zip Code:________________________________

Date of Birth:__________________ Age:_______ Sex: M F

Current Driver's License:  Yes _____  No ______

Issue Date:_________________________________

School Attending:____________________________

Parent/Guardian Phone#  Home:_________________________

Work: ____________Cell: _______________________

E-mail: ______________________________________

 

Statement  To  Students  and  Parents

We have a minimal amount of time to train young drivers to face the complex problems associated with today’s driving environment. The classroom material and range instruction is vital for understanding traffic situations and successful completion of the driving exercises. Students will be responsible for their own behavior while in the class. Therefore, any student acting in a manner that is considered disruptive or counterproductive to the teaching/learning process will be dismissed from the class. The instructor has full authority to do this, and his decision is final. There is a no refund policy if this occurs. We do not anticipate any problems, but this policy is for your safety and the safety of the other students.

By signing this form, I acknowledge that I am subject to dismissal from this class if my actions are considered disruptive or counterproductive to the teaching / learning process.

STUDENT:____________________________________________________

Parental consent:

The undersigned parent or legal guardian of the above named student hereby consents to the participation of said student and to the terms stated above.

PARENT OR LEGAL GUARDIAN________________________________________________

DATE_____________________

This statement must be signed by the student and parent/ legal guardian before the student will be enrolled into the class.

Completed registration form(s) and check(s) made payable to the Alabama Traffic Safety Center and Statement to Students and Parents must be sent to the following address:

Young Driver Risk Reduction Course
Alabama Traffic Safety Center
University of Montevallo, Station 6740
Montevallo, AL 35115