117 S Kent St, Winchester, VA 22601
 
 
 
Valley Driving School
 
 
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Learn to Drive Safely in the Shenandoah Valley and Beyond!

 

REGISTER NOW

DOWNLOAD PDF FORMAT
WITH ADOBE READER. SEND COMPLETED REGISTRATION FORMS VIA EMAIL TO:
valleydrivered@gmail.com
When you email your form include your NAME AND PHONE NUMBER
in the body of the email in case we have difficulty reading the form.
If you DO NOT receive a reply to your email with the registration form within 24 hours
call 540 398-6059 because we did not receive it if you do not hear from us.
FCPS students sending the form with an email ending in fcpsk12.net are having difficulty sending this attachment. Take a picture of the form and text it to the above
phone number.
CREDIT CARDS ACCEPTED FOR THE 36 HR online course and ADULT BTW sessions
 
Contact Us / Register for a course
____________________________________
NAME:
(Print as appears on you Learner’s Permit)
____________________________________

MAILING ADDRESS:
(List the home address where the driver may be picked up or dropped off)
____________________________________

DRIVER EMAIL:
____________________________________

NAME OF HIGH SCHOOL you attend
____________________________________

PARENT EMAIL: (if under 18)
____________________________________

DRIVER CELL PHONE:
____________________________________

PARENT CELL PHONE: (if under 18)
____________________________________

LEARNER’S PERMIT #:
____________________________________

DATE ISSUED:
____________________________________

DATE OF BIRTH:
____________________________________

AGE YOU ARE TODAY:
____________________________________

DEC1 CARD # (green card for under 18 drivers)
____________________________________

COURSE INTERESTED IN REGISTERING FOR:
____________________________________

BEHIND THE WHEEL TRAINING FOR TEEN UNDER 18 - $325
____________________________________

BEHIND THE WHEEL TRAINING FOR ADULT (18 & OLDER) - -$50 PER SESSION
____________________________________

8 HR DRIVER MANUAL COURSE - $225
(needed if client fails the learners permit test 3 times. Clients under 18 must have completed the 36 HR classroom course and hold the certificate from that course)
____________________________________

WHAT DATE WOULD YOU BE AVAILABLE TO START THE COURSE:
____________________________________

LIST ANY CONFLICTS OR TRIPS YOU HAVE PLNNED WITHIN 3 WEEKS OF THE ABOVE DATE:
____________________________________

WHAT IS YOUR DISMISSAL TIME FROM SCHOOL EACH DAY:
____________________________________

DO YOU PARTICIPATE IN ANY AFTER SCHOOL SPORT/ACTIVITY DURING YOUR REQUESTED TIME PERIOD
WHAT TIME DOES PRACTICE END?
LIST THE NAME OF ANY STUDENT DRIVER YOU WOULD LIKE TO PARTNER WITH FOR THE COURSE:
____________________________________
DOWNLOAD WITH ADOBE READER AND SEND THE REGISTRATION FORM VIA EMAIL TO:
valleydrivered@gmail.com
 
Contact us at (540) 398-6059 to learn more about our driving school.