4-Hour Winter Skills Clinic Registration

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

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

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

Yes

If no, he/she must be a licensed driver

Child(Required)

Son

Daughter

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

Mother's Name(Required)

First Last

Mother's Phone(Required)

Mother's Cell Phone(Required)

Mother's Email(Required)

Father's Name(Required)

First Last

Father's Phone(Required)

Father's Cell Phone(Required)

Father's Email(Required)

Driver License/Temporary Permit Number(Required)

100

Date Issued(Required)

Car Make to be used for Winter Skills Training(Required)

(ex. Ford)

Car Model to be used for Winter Skills Training(Required)

(ex. Mustang)

Car Year to be used for Winter Skills Training(Required)

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

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: $205.00

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

Mom or Dad additionally participating with Teen

Price: $155.00

Mom or Dad want to participate in the Winter Skills Clinic with their Teen.

Non-DriveTeam Student or Adult

Price: $255.00

Teen Drivers that received driver education from a different school

Parent Name

Total

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(Required)

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

Comments

This field is for validation purposes and should be left unchanged.

4-Hour Winter Skills Clinic

Please Pick an AM or PM Date

Online Payment

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