|S&B's Early Fall Session will begin on Sunday, August 16th. The parent meeting will be held
on Wednesday, August 12 at 6:30 p.m. The driving portion of the Early Fall Session may be
completed throughout the months of August, September and October. Please call 576-SAFE
or e-mail us at firstname.lastname@example.org for late registration or questions. Thank you!
Student Name______________________________ Date of Birth_____/_____/_____
(As it appears on Birth Certificate)
Address___________________________________ Home Phone_________________
_________________________________________ Cell Phone___________________
Emergency Contact_________________________ Emergency Phone_____________
Name of Nearest Relative___________________________________________________
Driving Group - Please list the names of 1 to 2 students who you would like to drive with during
your behind the wheel training. If you do not have a preference, leave this section blank and
you will be assigned a group randomly.
1) _________________________________ 2) ________________________________
Amount Paid ___________________ Amount Due ___________________
|S & B Driving School Registration Form
Please print and mail to 7484 Christina Drive, Suite 102 West Harrison, IN 47060 prior to the
parent meeting. You may call 576-SAFE if you need to rush register.
Sessions (circle one) Session Fee due at enrollment - $425.00
(Includes driver test waiver)
Fall Session 2015 - August and September
Late Fall Session 2015 - October and November
Winter Session 2015/16 - December, January and February