CENTRAL
Enrollment Application
DRIVING ACADEMY
Note:  
Maximum enrollment for each class is 25 students, enrollments are accepted on a                     
first come first served basis. We will send via e-mail a confirmation and enrollment package
with invoice. Tuition or balance of tuition fees are due on first day of class.
Central Driving Academy reserves the right to cancel any class for none or low                         
enrollments. Students may opt for another class or get a refund.
Teens are required to fill out parental information.
Student Information
(Please enter legal name as it appears on birth certificate no short or nick names)
First Name
Middle name
Last Name
Home Address
& Apartment
No.
City
Zip
State
Home Phone
Student Cell
                 
E-Mal
Birth Date
 Gender      
  
Weight
 Height
Eye
color
Hair Color
School attending
Father's name
Father's phone
Father's E-Mail
Mother's Name
Mother's Phone
Mother's E-Mail
Choose Course No., Date, and time
          Class No
       
Class Date
Class Time