Course Registration Form
Fill out the form carefully for registration
Course Specific Questions
Has the student completed any traffic safety education before?
Yes
No
Does the student currently have a driving permit?
Yes
No
Student Information
Student Name
*
First Name
Middle Name
Last Name
Grade Level
*
Student E-mail
*
example@example.com
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
School
*
Please Select
Allakaket School
Andrew K. Demoski School
Ella B. Vernetti School
Jimmy Huntington School
Johnny Oldman School
Kaltag School
Maudrey J. Sommer School
Merreline A. Kangas School
Minto School
Rampart School
Raven Homeschool
Other
Mobile Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Parent Information
Parent Name
*
First Name
Last Name
Parent E-mail
*
example@example.com
Work Number
Mobile Number
Phone Number
*
Back
Next
Eligibility & Consent
I understand that participation in this Driver’s Education course requires attending all 8 scheduled live virtual sessions on January 5, 12, 19, and 26; February 2, 9, and 23; and March 2. I agree to arrive on time, stay for the full duration of each class, and actively participate in the learning activities. I understand that excessive absences may result in not receiving credit or completion for this course.
*
Student agrees
Parent agrees
Media/photo consent (optional) I authorize the use of my photos in YKSD media and publications.
Yes, I approve
No, I do not approve
Confirmation student has reliable internet and Zoom access
Back
Next
Accommodations
Any learning or accessibility needs the instructor should know about:
Additional Comments
Submit
Should be Empty: