Driver’s Education Registration Form                                                                                                  
Safe Start Driving School                                                                                                                                                                       
217 2nd Avenue SW    Milltown, WI  54858                                                                                                         
(715)825-4950   cell  (715) 553-0474                                                                                                                 
website  www.SafeStartDrivingSchool.com                                                                                                                                                                
email  SafeStartDrivingSchool@yahoo.com
                                                                                                                                                                                                                                                 
Full Legal Name (print)____________________________________________________________________________________________________________________
(as it appears on Birth Certificate)                                      First                                                    Middle                                                             Last


Date of Birth_______________________ Cell Phone #____________________________________Parent Cell Phone#_______________________________________


Address________________________________________________________________________________________________________________PO Box  _________


City___________________________________________________________________________State__________________Zip________________________________


Parent/Guardian Name(print)_______________________________________________________________________________________________________________


Parent/Guardian Signature_________________________________________________________________________________________________________________


Student email address ____________________________________________________________________________________________________________________

Please check Boxes that apply:
        
Traditional Classroom   $125.00                                                                                                      
                                                                                                                                                                         
                                                                                                                                                                                                                
                                                                



                                                             
        
Online Classroom   $125.00    Signed contract must also be mailed   






        
Behind the Wheel   $315.00    Payable when BTW instruction begins   Payment Plan Available/Prices Subject to Change

        Online Transfer from other school   $125.00   Mail with Registration      Online Class Completion Certificate must also be mailed

          Office Use Only:
          Payment Received Date _____________________________Amt______________________________Check#_____________________________
                                                  By signing above you are releasing Community Education, participating School District and their
                                                                 employees from any liability due to injury or lost/misplaced personal items.

                                                                                                     
Mail this portion with payment
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Traditional Classroom
Fees are non refundable after 2nd class
After registering assume to be in the class unless otherwise notified
Class dates may change
Only 2 classes may be missed and must be made up
Online Classroom
Fees are non refundable
Student email address required
After receiving registration fee and signed contract, you will be emailed a password
Traditional Classroom
Fees are non refundable after 2nd class
After registering assume to be in the class unless otherwise notified
Class dates may change
Only 2 classes may be missed and must be made up.
Online Classroom
Fees are non refundable
Student email address required
After  receiving registration fee and signed contract, you will be emailed a password
Password will give you access to the Online School
Behind the Wheel Requirements
Student must 15 1/2 yrs to be eligible for permit
6 hours Behind the Wheel Instruction
6 hours Observation
Must have permit for 6 months
Traditional Classroom       School Location___________________

                                        Orientation Date__________________

                                                    Class Dates       __________________
              (Circle School Location)  
SCF    Luck   Siren   Frederic   Grantsburg
Start Date of Class ___________  
See website for list of Class Dates
           Dates Subject to Change    
Driver’s Education Registration Form
Safe Start Driving School    
Office      (715) 825-4950   cell (715-553-0474
website:  www.SafeStartDrivingSchool.com   
email:      SateStartDrivingSchool@yahoo.com