Register for the Course | HighSchoolDriversEd.com

Student name and birth date must appear on this form as they do on the student's birth certificate.

Account Login Information
You will need a username and password to access the online course. Please choose your login information below:

Choose Username
Choose Password
Confirm Password

Discount Code

Student Information
First Name
Last Name
Phone Number	(xxx-xxx-xxxx)
Email Address

Birth Date
Gender	male female

High School
Does your high school offer driver's education? no yes

How did you hear about us?


Referral Code

Mailing Address
Mailing Address Street


Mailing Address City
Mailing Address State
Mailing Address Zip Code


Billing Information


	billing address is the same as the mailing address
Billing Address Street


Billing Address Zip Code
Parent or guardian certifies that: I have read the terms and conditions of this course. All statements made on this form are correct. *Note: Once you submit the form your credit card will be charged $69.95 plus $0.00 for the read along option minus any applicable discounts.