Driver's Education Registration Form

Please read the Driver' Ed letter before filling this form. Please fill and click Submit.

Student's Name *
Student's Name
Student's Birthdate *
Student's Birthdate
Parent's Name *
Parent's Name
Address *
Address
Home Phone
Home Phone
Cell
Cell
We must have a parent volunteer at the security desk for each class. The parent will ensure that all students are picked up after the class. Classes will be held from 2:45 p.m. – 4:45 p.m. on Thursdays on the following dates: Sept 12, 19, 26 Oct 3, 10, 17, 24 Nov 14, 21 Dec 5 Please list the dates for which you are available. Parents will be notified of their assigned dates before the beginning of the course. Any parent not assigned a particular date will be on a substitute list, and may be contacted as needed.

HAVE YOUR CHILD BRING IN PAYMENT ON THE FIRST DAY OF CLASS. 

PAYMENT OF $150 CAN BE CASH, MONEY ORDER OR CERTIFIED CHECK MADE PAYABLE TO:   GEORGE CLAYTON, PRESIDENT COAST AUTO DRIVING SCHOOL, INC.

GRADUATES OF THE CLASS WILL RECEIVE A CERTIFICATE WHICH MAY BE USED FOR A REDUCTION ON YOUR AUTO INSURANCE. 

Questions? Contact:

George Clayton, Coast Auto Driving School 732-531-1378, or

AAHS Driver’s Ed–Chair-Person: Mehbuba Rahman at meana129@gmail.com