City, State & Zip Code:______________________________________
Date of Birth: __________________ Age: ______ Sex: M F
Learner’s Permit License Yes ______ No_______
Issue Date: ____________________ ( Must have permit for at least 3 months)
(Learner's Permit Students ONLY in Novice Driver Class)
Parent/Guardian Phone# Home: ________________________
Work: __________________Cell: _______________________
Statement To Students and Parents
We have a minimal amount of time to train young drivers to face the complex problems associated with today’s driving environment. The classroom material and range instruction is vital for understanding traffic situations and successful completion of the driving exercises. Students will be responsible for their own behavior while in the class. Therefore, any student acting in a manner that is considered disruptive or counterproductive to the teaching/learning process will be dismissed from the class. The instructor has full authority to do this, and his decision is final. There is a no refund policy if this occurs. We do not anticipate any problems, but this policy is for your safety and the safety of the other students.
By signing this form, I acknowledge that I am subject to dismissal from this class if my actions are considered disruptive or counterproductive to the teaching / learning process.
The undersigned parent or legal guardian of the above named student hereby consents to the participation of said student and to the terms stated above.
PARENT OR LEGAL GUARDIAN________________________________________________
DATE_____________________This statement must be signed by the student and parent/ legal guardian before the student will be enrolled into the class.
If there are any emergency medical needs that we need to be aware of, or if participants wish to request reasonable disability-related accommodations, please contact us at 205-665-6740 with as much notice as possible. Attempts will be made to meet late requests, but they cannot be guaranteed.
Completed registration form(s)
and check(s) made payable to the Alabama
Traffic Safety Center must be sent to the
Novice Driver Training Course
Alabama Traffic Safety Center
University of Montevallo, Station 6740
Montevallo, AL 35115