Point Reduction Course Enrollment

Point Reduction Enrollment Form

Complete all sections to enroll in your point reduction class

Select Point Reduction Class

Point Reduction Class

Student Personal Information

First Name*

Middle Name

Last Name*

Suffix

Goes By (Preferred Name)

Gender*

Date of Birth*

Student Contact Information

Phone Number*

Only used for contact about lesson changes if a minor.

Email Address*

This email will be used for login.

Student Address

Street Address*

Apartment/Unit

ZIP Code*

Student License Information

License Number*

Issue Date

Emergency Contact - Primary

Full Name*

Phone Number*

Email Address*

Relationship to Student*

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We never share your mobile opt-in information with anyone. Read our Privacy Policy and SMS Terms and Conditions.

Emergency Contact - Second

Full Name

Phone Number

Email Address

Relationship to Student

How did you hear about us?*

Google Ad

Google Search

Facebook Ad

Family of Prior Student

Family / Friend / Acquaintance

Talked to the office personnel

Talked to an instructor

Other

Printed Signature*

Signature*