Full First Name:
Middle Initial:
Full Last  Name:
Address:
City:
Zip Code:
Phone Number:
Email:
Date of Birth:
Start Date:
Class time:
Classroom Location:
Teen Classroom Registration Form
Please fill in the information as it appears on your birth
certificate then click the submit button only once.
Please remember to bring a check in the amount of
$100.00 made out to Main Street, a credit card, or cash
with you on your first day of class.
Main Street
Driving School