MIDCOAST DRIVING SCHOOL

Clute Location: Student Registration Form

Fill out the form carefully for registration
Student Name *

First Name Middle Name Last Name
Date

Month Day Year
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Birth Date *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent E-mail *
Student Number *

Area Code Phone Number
Parent's Number *

Area Code Phone Number
My Products *
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Student In-Class Instruction $ 300.00

Student Driving Instruction $ 300.00

Student In-Classroom & Driving Instruction $ 375.00

adult min* of three hours of driving $ 150.00

Adult Driving Course $ 75.00
Date

Month Day Year

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Date

Month Day Year

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Best Driving School Ever!