SWIFT DRIVING & TRAFFIC WOLATOR SCHOOL
411 E 18th STREET STE. D
OAKLAND, CA 94606
(510) 839-3819


ONLINE DRIVER EDUCATION COURSE
ENROLLMENT FORM


STUDENT INFORMATION:


STUDENT'S FULL NAME:_______________________________________________________

PARENT/GUARDIAN NAME:____________________________________________________

ADDRESS:____________________________________________________________________

CITY:____________________________________STATE:___________ZIPCODE:__________

PHONE NUMBER:_____________________________________________________________

EMAIL ADDRESS:_____________________________________________________________

DATE OF BIRTH:______________________________________________________________

In order for the student to have access to the study materials online, they must have a username and password. This information will be kept confidential.

USERNAME:_______________________________________PASSWORD:_________________

TO BE FILLED OUT BY PARENTIGUARDIAN OF STUDENT ENROLLING

I allow my son/daughter ______________________________to enroll in Swift Driving School’s online Driver’s Education course. I understand that there will be no refunds once the student is enrolled. Upon completion of the course, the student will receive their completion certificate (pink) in the mail.

Please mail check/money order payable to Swift Driving School along with this enrollment form.

Parent Signature:___________________________________Date:_______________________

* After we have received your enrollment form in the mail, we will send you a confirmation via email with your username, password and confirmation number.

To be filled out by Swift Driving School Employee


Date enrolled:_______________________________________

Confirmation number:________________________________