Price Driving Anderson South Carolina

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Stu Date

Stu IP

Pick Class Date
Student Full Name	Student Name
Are you 15, 16 or 17 as of class date? Check for YES	YES Age
Student Date Of Birth	Student DOB
Does the student have any physical, visual, or mental handicap the School or instructor should be aware of, for the safety of the student? i.e. SEIZURES, EPILEPSY, DIABETES, ETC. Check for NO	NO Health Care Check
Do you possess a Valid SC Beginner's Permit from SC Dept of Motor Vehicle. Check for YES	YES Beginners Permit
Enter your SC Beginners Permit Number (Red Starts with DL#)	Permit/DL#
Phone Number	Phone Number
Student Street Address
City
State
Zip Code
Parent Full Name
Parent's Email Address	Email Email
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