Teen Permit Enrollment Page

TEEN PERMIT COURSE ENROLLMENT FORM

* Indicates required field

CLICK TO SELECT DATE/LOCATION *

First Name (Legal) *

Middle Name (If student has one) *

Last Name (Legal) *

DOB *

Age (1st day of class) *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Phone Number *

High School Attending (if Applicable) *

Grade (if Applies) *

Home schooled? *

YES

Choose One *

"Already have TIP Card" "Have appt to get TIP Card" "Will make appt for TIP Card"

TIP CARD ISSUE DATE (If Available) *

TIP CARD # (If available). *

Upload PICTURE OF TIP CARD (IF AVAILABLE) *

Max file size: 20MB

NOTE:
PLEASE OBTAIN YOUR STUDENT'S TIP CARD BEFORE THE CLASS. STUDENTS WHO DO NOT HAVE THE TIP CARD MAY ATTEND THE CLASSROOM PORTION, BUT CANNOT TAKE THE OMV TEST ON THE LAST DAY OF THE CLASS. HE/SHE WILL BE REQUIRED TO RETURN LATER FOR A SPECIAL TEST SESSION (1:1 OR SMALL GROUP) ONCE THEY HAVE OBTAINED THE TIP CARD FROM THE DMV. TEST SESSION FEE IS $25 (Applies to all tests and retests given outside of the 30-hour course). ALTERNATIVELY, YOU MAY OPT TO ENROLL YOUR TEEN IN A FUTURE COURSE DATE AFTER THEY HAVE OBTAINED THE TIP CARD.

Legal Parent/Guardian *

First

Last

Parent/Guardian Ph. Number *

Email Address of Legal parent/guardian *

Check locations where student has driving experience. (Check all that apply). *

PARENT PLEASE CONFIRM: MY STUDENT HAS DEMONSTRATED THE MATURITY LEVEL NECESSARY FOR ATTENDING THE CLASSROOM DRIVER'S LICENSE EDUCATION COURSE AND PARTICIPATING IN THE BEHIND THE WHEEL TRAINING. I ACCEPT THE RESPONSIBILITY OF DISCUSSING WITH MY TEEN THE NECESSITY OF FOLLOWING THE GUIDELINES AND RULES AS SET FORTH BY THE LOUISIANA OMV AND NORTHWEST DRIVING ACADEMY, IN PARTICULAR BEHAVIORAL AND CLASSROOM PARTICIPATION EXPECTATIONS (SEE PARENT ORIENTATION DOC FOR MORE INFO) *

YES

I do hereby certify that I am the Legal Parent/Guardian of the minor applying herein, I have read this form, and this is my authorization granted to Northwest Driving Academy to administer the Teen Permit driver education course. I also declare by my Electronic signature below that the information I have provided is complete and accurate. (LEGAL PARENT/GUARDIAN, TYPE NAME BELOW). I agree to sign a hard copy at the office at a later date. *

REMINDER: PLEASE DO NOT SUBMIT THE FORM IF... you are not prepared TODAY to pay at least the minimum payment of $225 REQUIRED to reserve a seat in the class. UNPAID REMAINING BALANCE are due by the end of the day the MONDAY of the week before the class. Course Fee includes the down payment amount. MONITOR your email closer to the first date of class for more Class Info, including Balance Payment Link and Mandatory Parent Orientation Document.

BEFORE YOU ENROLL. Click here ->IMPORTANT DISCLOSURES ABOUT THE BEHIND-THE-WHEEL PORTION (OPENS IN NEW WINDOW).

Thank you.