We are currently looking for instructors. If you are interested in helping teach the next generation of drivers, please contact our office for more details.

Adult Beginner Course Enrollment

Please complete the form as completely as possible to start your enrollment in our school.

Class Date and Program Selection

Select Class Date

Training Package

Student Information

First name*

Middle Name

Last name*

Goes by?

Street Address*

Apt

Neighborhood

City*

State*

Zipcode*

Student Email*

Student Phone*

Birthdate*

SC Permit/License #

Permit/License Issue Date

Gender*

Emergency Contact Information

Contact #1 Name

Contact #1 Phone

Contact #2 Name

Contact #2 Phone

Student Medical Information

Does the student wear glasses / contacts?*

Yes

Does The Student Have Any Impairment That Would Prevent Him / Her From Receiving And Applying Verbal Instruction / Direction ? If So, Please Explain:*

Are There Any Conditions That We Should Know About That Could Affect A Student's Driving Capability Physically?*

Does The Student Take Any Medication? If So, What Kind & What Is It For? (Please List All)*

Please Let Us Know If The Student Has Ever Been Diagnosed With Any Of The Following: (Check all that apply)

Not Diagnosed

Paralysis

Hearing Difficulties

Heart Trouble

Seizures

Perception Difficulties

Epilepsy

Orthopedic Difficulties

Autism/Aspergers

Comments*

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