Phone: 920.785.5939

Log In to Online Course

Registration

Use this form to register for behind-the-wheel and in-person class sessions

Service Information

Select a Service/Class Session*

Student Information

Legal First Name*

Legal Middle Name*

Legal Last Name*

Preferred Name*

Email*

Birth Date*

Home Phone*

Sex*

Cell Phone*

Name of student’s High School*

Primary Residence

Street Address*

City*

State*

Zip Code*

Secondary Residence

Street Address

City

State

Zip Code

Parent/Guardian 1

Parent 1 First and Last Name

Parent 1 Email

Parent 1 Home Phone

Parent 1 Work Phone

Parent 1 Cell Phone

Parent/Guardian 2

Parent 2 First and Last Name

Parent 2 Email

Parent 2 Home Phone

Parent 2 Work Phone

Parent 2 Cell Phone