4-Hour Winter Skills Clinic Registration

Student's Name*
First Last
Date of Birth*
MM slash DD slash YYYY

mm/dd/yyyy
Address*
Street Address City State ZIP Code
Is he/she a DriveTeam Current Student/Graduate*
- Yes
- No
If no, he/she must be a licensed driver.
Child*
- Son
- Daughter
Does the Participant(s) have any medical issues, or taking medication?*
Mother's Name*
First Last
Mother's Phone Number*
Mother's Cell Phone Number*
Mother's Email*
Father's Name
First Last
Father's Phone Number
Father's Cell Phone Number
Father's Email
Driver License/Temporary Permit Number*
Date Issued*
MM slash DD slash YYYY
Car Make to be used for Winter Skills Training*

(ex. Ford)
Car Model to be used for Winter Skills Training*

(ex. Mustang)
Car Year to be used for Winter Skills Training*
Auto Insurance Carrier for Student and Car to be used*

Online Payment
Please select the appropriate price category. Then submit registration to begin your online transaction with PayPal.
Name on Credit Card*
First Last
Customer Email*
DriveTeam Student Quantity
Price: $195.00
If you're were a DriveTeam Student please select this discounted price
Mom or Dad additionally participating with Teen Quantity
Price: $125.00
Mom or Dad want to participate in the Winter Skills Clinic with their Teen.
Non-DriveTeam Student or Adult Quantity
Price: $249.00
Teen Drivers that received driver education from a different school
Parent Name
Total
$0.00
In consideration of my attendance at or participation in a DriveTeam, Inc. 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*
- I agree with DriveTeam's Waiver of Liability & Release form
Phone
This field is for validation purposes and should be left unchanged.

4-Hour Winter Skills Clinic

Step 1 of 3

Please Pick an AM or PM Date

Online Payment

In consideration of my attendance at or participation in a DriveTeam, Inc. program or clinic:

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