Teen Driver Challenge Registration – Orange County Sherriff's Office

NON-EMERGENCY: (407)836-4357

EMERGENCY: 9-1-1

RECORDS: (407)254-7280

Teen Driver Registration

Class Date

Date:

Student Information

Student First Name:

Student Last Name:

Student Middle Name:

Student Preferred Name:

School/Academy Attend:

Date of Birth:

Age:

Address:

Address 2:

City:

State:

Zip:

Student Phone number:

Student Email:

Learner's Permit/Driver's License Number:

Select your license type:

Number of months practiced driving on actual roads
(at least 6 months to be considered):

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

Select a shirt size:

Parent/Guardian Information

Full Name:

Phone Number:

Email: