Fill out the form below and pay online, or print out a copy of the form and pay in person.

Basic Information
How did you hear about us?
Class Start Date ONLINE
Student Information
First Name*
Middle Name* (full name, not just initials! don't have a middle name?)
Last Name*
School
Date of Birth*
Eye Color
Cell Phone (no dashes)
Email
Medication* (write "none" if none)
Parent Information
Address*
City*
Zip Code*
Home Phone (no spaces or dashes)*
Mother Name*
Mother Work
Mother Work Phone
Mother Cell Phone (no dashes)
Mother Email
Father Name*
Father Work
Father Work Phone
Father Cell Phone (no dashes)
Father Email

You must be 14 1/2 years of age to begin the 30-hour online class. This program is approved through the State of Colorado, and allows minors between the ages of 15 and 15 1/2 to obtain their permit. A minimum of 30 hours must be logged online before a completion certificate will be issued. This contract is non-transferable and tuition fee is non-refundable.
Signatures
Student Signature* Date
Parent Signature* Date