For which location/school would you like to register?
(To have available dates and locations sent to you, click here)
 


All students will attend the weeknight classroom session.
Which behind-the-wheel driving session is most convenient for you?
 
#1: Saturday, 8:00 a.m. to 12:30 p.m.
#2: Saturday, 1:30 p.m. to 6:00 p.m.
#3: Sunday, 8:00 a.m. to 12:30 p.m.
#4: Sunday, 1:30 p.m. to 6:00 p.m.

Student's Given Name: 

Student's Date of Birth (MM/DD/YYYY): 

Which High School does/did your student attend:
 


Parents' Names:   

Address: 

City:      State:      Zip Code: 

Phone (Day):      Phone (Evening): 

E-Mail: 

How were you referred to the program?
 


Will you be paying by check or money order*?  Yes   No
 
If not paying by check* or money order*, what is the most convenient time to contact you for credit card information?
 

 
*Checks and money orders are accepted up until 10 days prior to the event and should be made payable to: SRE, 2364 Lower Roswell Road, Marietta, GA 30068