2017 Peshtigo High School Driver Education Registration
Complete this form to register a student for the 2017 Driver Education Program at Peshtigo High School.  Information entered will be used to distribute the students evenly between the sections of classroom and for contact with parents/students throughout the Driver Education Program.

Please read the Parent Letter to understand the registration process and classroom/behind the wheel requirements.  Students must be 15 years old before the first day of classroom.

The first email address question is used to send information back to you for review.  Please check your email and make any changes/corrections in the form immediately after submitting the form.  The email address entered in the Parent email question will be used to distribute information throughout the Driver Education course. (these can be the same)
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Email *
STUDENT INFORMATION
Student's FIRST Name *
Legal Name as it appears on Student's Birth Certificate (no nicknames)
Student's MIDDLE Name *
Legal Name as it appears on Student's Birth Certificate
Student's LAST Name *
Legal Name as it appears on Student's Birth Certificate
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Phone Number
Primary Number (can be cell or home) NO dashes
Home Address *
City, State, Zip Code *
Student Email Address *
All Peshtigo Students have an email address.  (gradyr-last-first)@students.peshtigo.k12.wi.us  (Example:18huxthe@students.peshtigo.k12.wi.us) Ask the student if not sure.
Does the student attend Peshtigo High School? *
If no, give name of school in "other" line.
Does the student live within the Peshtigo School District boundaries? *
PARENT INFORMATION
Parent/Guardian's Name(s) *
Parent Phone Number *
Primary Number (can be cell or home)
Parent Email Address *
CLASS CHOICES
Use the following to select a classroom time for the student to attend.

Student must be 15 years old before the first meeting of the class.

Don't select the same class more than one time.

Class Choice *
This is the best option for the student to attend class. It is not guaranteed that the student will be placed in this class, it will depend on the number of students signing up for this class and the age of the students signing up.
A copy of your responses will be emailed to the address you provided.
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