South Louisiana's Finest Driving School
Located in Houma and Larose

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38 and 14 Hour Driving Classes
Official OMV Testing
Road Skills Testing

Dane Voisin (Owner/Instructor)

STUDENT REGISTRATION FORM

14-Hour

Must be at least 18 years old. One day of classroom instruction and eight hours of behind-the-wheel driving. Official OMV Test administered at the end of the class day.

SESSION July 28, 2018
First Name
(max 30 characters a-z and A-Z)
Last name
(max 30 characters a-z and A-Z)
Date of Birth
Email Address
Home Phone Number
(10 digit number)
Student's Cell Phone Number
(10 digit number)
Parent's Cell Phone Number
(10 digit number)
GENDER Male Female
ADDRESS


CITY
(max 30 characters a-z and A-Z)
ZIP CODE
STATE
(max 2 characters A-Z)
Parent/Guardian's Name
HIGH SCHOOL
Grade Level--Student must be in at a minimum in the 8th grade
Medical Questions






Does the student have any medical conditions that would pose concerns with the students behind the wheel instruction (epilepsy,asthma, colour blindness, hearing loss, etc...)?
Yes No
Does the student have any mental/physical impairments which could affect the ability to drive a motor vehicle safely?
Yes No
Has the student experienced unconsciousness other than normal sleep?
Yes No
Is the student's visual acuity at least 20/40 corrected?
Yes No
Does the student require any special accommodations to participate in this course(i.e.,oral tests,interpreter,seating arrangements,adaptive equipment)?
Yes No
Student's Driving Experience


None
Subdivision
Parking Lots
Rural Roads
In Town
Highway
Interstate
Notes (List members of group registration or other notes for instructor.)