Driver's Education Registration 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
Dates You are available
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. Please circle the dates below 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