FLORIDA SHERIFF'S ASSOCIATION TEEN DRIVER CHALLENGE

07/10/21

Institute of Public Safety Driving Range
13000 Frankie' Rd
Tavares, FL 32778

Student Driver Information

STUDENT DRIVER'S NAME:
DATE OF BIRTH:
DRIVERS LICENSE NUMBER:
STATE:
Is your participation in this class court-ordered?
Street Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Student Email:
High School:
Grade:
Parent/Guardian Name:
Parent/Guardian Email*
Contact Phone:
*Parent/guardian email address will be used for follow-up information and additional registration forms.

Are you taking medication that would affect your ability to operate a vehicle?

Are there any health issues that prevent you from participating in the program?