4-Hour Advanced Teen Driving Clinic

4-Hour Advanced Teen Driving Clinic Registration Form

Step 1 of 2

Are You a DriveTeam PBDE Student?(Required)

YES

Student Name(Required)

First Last

Date of Birth(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Is he/she a DriveTeam Current Student/Graduate(Required)

Child(Required)

Does the Participant(s) have any medical issues, or taking medication?(Required)

Mother's Name

First Last

Mother's Phone(Required)

Mother's Cell Phone(Required)

Mother's Email(Required)

Father's Name

First Last

Father's Phone(Required)

Father's Cell Phone(Required)

Father's Email(Required)

Driver License/Temporary Permit Number(Required)

Date Issued(Required)

Car Make to be used for Advanced Teen Skills Clinic(Required)

(ex. Ford)

Car Year to be used for Advanced Teen Skills Clinic(Required)

Auto Insurance Carrier for Student and Car to be used(Required)

Please Pick an AM or PM Date

May 31, 2024

AM - 5/31/24

May 31, 2024

AM - 5/31/24

June 6, 2024

AM - 6/06/24

PM - 6/06/24

June 14, 2024

AM - 6/14/24

PM - 6/14/24

Online Payment

Please select the appropriate price category. Then submit registration to begin your online transaction with PayPal.

Name on Credit Card(Required)

First Last

Customer Email(Required)

DriveTeam Student Price

DriveTeam Student

Price: $205.00

If you're were a DriveTeam Student please select this discounted price

Non-DriveTeam Student

Price: $255.00

If you're were a DriveTeam Student please select this discounted price

Total Cost

Total

In consideration of my attendance at or participation in a DriveTeam Akron LLC program or clinic:

1. I hereby knowingly and voluntarily waive forever any and all liability on the part of, and covenant not to sue or institute any legal claim against DriveTeam Akron LLC., its instructors, insurers, property owners, successors or assigns, or any sponsor, resulting from or arising out of or in connection with my attendance at or participation in a DriveTeam Akron LLC. program or clinic.

2. I hereby knowingly and voluntarily assume full responsibility for the risk of bodily injury, death, or property damage incurred by me as a result of my actions, or of any accident, collision, act of God or act or failure to act of DriveTeam Akron LLC. or of any sponsor, in connection with my attendance at or participation in a DriveTeam program or clinic.

3. This Waiver of Liability and Release shall be binding upon me and my personal representatives, assigns, heirs and next of kin.

Agreement(Required)

I agree with DriveTeam's Waiver of Liability & Release form