Coastal Community Driving School

ENROLL ONLINE

Dear Applicants,

Classes are filled on a first come, first serve basis only after we receive your application
and a $75. non-refundable registration fee. Check should to be sent to: C.C.D.S., 7 Sunny Crest Rd.,
York, ME 03909. Should the requested class be full, you will be placed in the next available
class. -Mr. B with CCDS

Student's Name:	*First MI Last*
Present Class:
Date of Birth:
Corrective Eyewear Used:	Glasses Contacts None
If student has any medical conditions requiring medications, please specify:
Parent's Name:
Address:
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone 1 & Owner:
Cell Phone 2 & Owner:
Contact to speak with for scheduling purposes and best time to call (ie. mother after 5pm weekdays)
E-mail Address:
Course Period Desired:
Please list days of week student is available and exact times of availability:
How you were referred to us:	Friend Newspaper Web Site Brochure Search Engine Other
Please use this space to add any additional info such as study halls available, second preferences, etc., that will help us:

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