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Defensive Driving (English)

Court-approved ticket dismissal course

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Student Information

First Name *

Last Name *

Date of Birth *

Is the student a minor (under 18)?

Student Email *

Student Phone

Parent / Guardian Information

Required for students under 18. A parent or guardian must sign consent forms at the school before the first class.

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone *

Address

Street Address

City

ZIP Code

Additional Notes

Questions or special requests (optional)

I confirm that the information above is accurate. I understand that a school representative will contact me to confirm scheduling and payment. For students under 18, I acknowledge that a parent or guardian must be present at the school to sign required consent forms before the first class.

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