Minnesota Registration Form - Heavy D Driving School

Minnesota Student Registration Form

Is the student under 18 years old?(Required)

Yes

Has the student had the required classroom training?(Required)

Yes

We will need a copy of the classroom certificate, behind the wheel contract and part ($150) or all the $380 behind the wheel fee. Please fill out this form to request enrollment:

MN requires 30 hours classroom training. I have a wonderful option of an asynchronous course. Please check out the following information: Asynchronous Click to view video advertisement The website enrollment link: MNDE.CruiseControlEducation.com Be sure to use the coupon code: heavy2468 Cost is $100 When finished be sure to email heavyddriving@gmail.com to find out how to enroll into behind the wheel and get an ‘ecard’ to take the permit test.

Do you have a valid permit?(Required)

Yes

Please fill out this form to request availbility:

We are not able to provide training until a permit is acquired.

Student Name(Required)

First Middle Last

Address(Required)

Street Address City State ZIP Code

Student Date of Birth(Required)

Email Address(Required)

Cell Phone(Required)

Student's High School(Required)

Student's High School

Does the student have any medical conditions, physical limitations, or take any medications that might affect their ability to drive or participate in driving lessons?

Has your permit or license been revoked due to Vanessa's Law or violations?(Required)

Yes

Did the DMV require you take further training due to test failure?(Required)

Yes

Have you taken the road test at the DMV?(Required)

Yes

What is your expected testing date?

Permit Number

Parent/Guardian Name

First Last

Parent Cell Phone Number

Parent Email Address

Cancellation Policy

If you must cancel a Behind the Wheel instruction session, you must give 48 hours notice by emailing heavyddriving@gmail.com. If you do not provide 48 hours notice, you will be charged a $50 fee.

Please type the student's initials here to indicate your understanding of the cancellation policy.(Required)

Terms

Filling out this form does not guarantee that you will be scheduled. Availability is limited. We will contact you prior to taking payment to make sure appointments are available.

Student Signature (please type below)(Required)

Today's date(Required)

Parent/Guardian Signature (please type below)

Today's date