Teen Registration for PBDE Full Program and 2-Day Advanced Skills

Name

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

Student Name(Required)

First Last

Gender(Required)

Male

Female

Date of Birth(Required)

Both Parents in House?(Required)

Yes

No

Student Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Cell(Required)

Student Email(Required)

High School(Required)

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

Vision Correction?(Required)

Any Vehicular Trauma?(Required)

Parent Information

Mother's Name(Required)

First Last

Mother's Employer and Position(Required)

Mother's Home Phone(Required)

Mother's Cell Phone(Required)

Mother's Email(Required)

Father's Name(Required)

First Last

Father's Employer and Position(Required)

Father's Home Phone(Required)

Father's Cell Phone(Required)

Father's Email(Required)

Driving Information

Temporary Permit Number(Required)

Date Issued(Required)

Car Make to be used for Skills Training(Required)

(ex. Ford)

Car Make to be used for Skills Training(Required)

(ex. Mustang)

Car Year to be used for Skills Training(Required)

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

Please Pick Desired Skills Weekend

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August 8-9, 2026

8/8-8/9, 2026

This field is hidden when viewing the form

August 22-23, 2026

8/22-8/23, 2026

September 12-13, 2026

9/12-9/13, 2026

September 26-27, 2026

9/26-9/27, 2026

October 10-11, 2026

10/10-10/11, 2026

October 24-25, 2026

10/24-10/25, 2026

Online Payment

Please select the appropriate price category. Then submit registration to begin your online transaction with PayPal. *Fees will be deducted from any reimbursement.

Name on Credit Card(Required)

First Last

Customer Email(Required)

Performance Based Driver Education Program

Price: $895.00

Full Teen Driver Education Program

Total

Other Payment Options

Pay By Check

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

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

Teen Registration

PBDE Registration

Parent Information

Driving Information

Please Pick Desired Skills Weekend

Online Payment

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