Safe Wheels Driving School, LLC Permission Form

Date: 02/23/18

After reviewing the School Contract Guidelines, I hereby give permission for my son/daughter,

(Print full name as it appears on birth certificate)
Please note: A copy of your birth certificate will be needed for the first class.

Sex: Male Female

(Date of Birth)

to take driver education as offered by Safe Wheels Driving School. To the best of my knowledge, he/she has no physical or mental problems that would interfere with the safe operation of an automobile. Finally, I understand that an employee, so designated by Safe Wheels Driving School, may ask for a professional evaluation if they feel such an evaluation is warranted.

Per recommendation of the NH Department of Safety, please answer the following questions:

  1. Are the driving privileges (not license) for the person enrolling in this driver education program currently under suspension or revocation?
    Yes No
  2. Is there any pending action against the person enrolling in this driver education program which would cause the driving privileges to be suspended or revoked in the future?
    Yes No
  3. Should the driving privileges of the person enrolled in this driver education program become suspended or revoked during enrollment for any reason, we will report it to the driving school administrator immediately?
    Yes No

Session requested:

Parent or Legal Guardian:

Student's Address:

Telephone Number:

Contact Email (One Parent):

By submitting this form, you agree to all terms of the Program Guidelines.

Important note: you must submit this form (by actually clicking the button) in order to register. After the form has been submitted, you will be asked to print, sign, and send a confirmation page.

Please send it to:

Safe Wheels Driving School
PO Box 622
Hampton Falls, NH 03844

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