Form for Online Course (DE101)
DO NOT SUBMIT THIS FORM UNLESS YOU INTEND ON ENROLLING IN THE COURSE IMMEDIATELY
 *Is a required field

Step 1

*Student First and Last Name
* DOB: mm/dd/yyyy
*Address, City, Zip
, , CA
*Phone + Area Code
 
*Cell/Other + Area Code
 
* High School Student Attends :  
* Student * Parent e-mail:
*Parent or Guardian Name
*Parent / Guardian Phone
*Method Of Payment: *Enter Method of payment here.
Please acknowledge that you have read and the following terms and conditions by entering your initials in the box below.
1 It is agreed that you are enrolling in a distance learning or online course.
2 You understand that the online version of this course is identical to the course that is taught live. However, you are aware that an online course requires more self-discipline than a live course.
3 You understand there is a 65-day maximum period from the date of enrollment to complete the course.
4 You understand that this course is not transferable into any other course.
5 You understand that should you choose not complete the course, a certificate cannot be issued.
6 You understand that refunds are not available once you begin the course.
You have read 1-6 above and agree by entering your initials here:
You have or are you planning to enroll into an EZ Driving School location for for driver training?  (yes, no, I don't know)
Enter the location that is closest to you. If you don't know use this:

* Student Signature