Registration Form - 16 year old Before enrolling, please call our office at 856.235.7333 to schedule a date and time for a Registration Meeting. The 30-minute meeting includes a required Vision Test, Knowledge Test (unless student already passed it in high school), and a Parent Orientation Session. The student will be completing the application for the student permit. For your convenience, we have weekday appointments, both day and evening, in our Moorestown Office. A parent or guardian must attend with the student. The student will be required to bring the following to the scheduled meeting: Student’s original, birth certificate OR valid, signed passport, or passport card Proof of Knowledge Test if passed in High School – Print a hard copy of the Web Receipt including the Bar Code Copy of student’s Social Security Card Glasses or contacts, if needed, for Vision Test Deposit of $95, payable by check, cash, or credit card.Requirements Acceptance(Required) I understand the requirements for registration. Student InformationStudent Name(Required) First Last Student Phone(Required)Student Email(Required) Address(Required) Street Address City State Zip Code Student Birthday(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleOtherHigh School Other:(Required) Have you passed your written test in school?(Required) Yes No Do you wear glasses or contacts?(Required) Glasses Contacts Both None Registration Appointment Date(Required) Month Day Year Registration Appointment Time(Required) Hours : Minutes AM PM AM/PM Parent/Alternate Name(Required) First Last Parent/Alternate Email(Required) Parent/Alternate Phone(Required)Driving ProgramsPlease select a driving program: Advanced Program *Best Value* Six, 2-hour Lessons = 12 hours ( $875.00 ) This comprehensive program includes sufficient practice time for students to become more proficient in all aspects of beginning driving. This course is designed to better meet the needs of students with infrequent home practice or those who simply want additional driving experience. Intermediate Intermediate Program - Five, 2-hour Lessons = 10 hours ( $750.00 )Our basic program PLUS an additional 4 hours to smooth out any rough areas plus concentration on advanced skills including highway driving. Basic Basic Program - Three, 2-hour Lessons = 6 hours ( $495.00 * includes a $95 deposit at registration appointment ) The Basic Program is the minimum requirement for all 16 year-olds. Additional ServicesAdditional Services Review Lesson/s ( $175.00 each ) This 2-hour lesson will boost your confidence and prepare you, not only for the Road Test, but for life without a supervised driver. Road Test Service Road Test Service, Cherry Hill or Delanco ($125.00 CASH ONLY) The road test service includes the use of our car for your Road Test. Our knowledgeable instructor will give you some helpful tips and review the course prior to your appointment. A great value for busy parents. Additional Details/Comments?Please provide any information that would help us get to know you so that we can make your driving school experience first-rate. For example: Do you have any health issues such as anxiety, diabetes, or disabilities of any kind?How did you hear about us?GoogleFacebookFriendFamily MemberSchoolInternetSaw a South Jersey Driving School CarBurlington County Chamber of CommerceOtherAgreement and PermissionsAs the student, I certify all statements are true(Required) As the student, I certify that all statements are true. (required) As the Parent/Guardian, I hereby give full consent for the student to participate in Behind the Wheel instruction with a South Jersey Driving School, Inc. licensed, trained driving instructor.(Required) As the Parent/Guardian, I hereby give full consent for the student to participate in Behind the Wheel instruction with a South Jersey Driving School, Inc. licensed, trained driving instructor. (required) Untitled I allow the use of photos of myself/the student in social media, website, and print material for South Jersey Driving School, Inc. PhoneThis field is for validation purposes and should be left unchanged.
