Coastal Community Driving School

ENROLL ONLINE

Dear Applicants,

Classes are filled on a first come, first serve basis only after we receive your application or a mailed copy of the application along with a $75 non-refundable registration fee.

Check should to be sent to:

C.C.D.S.
7 Sunny Crest Rd.
York, ME 03909

Should the requested class be full, you will be placed in the next available class.

-Mr. B with CCDS

Student's Name:
First MI Last

Present Class:

Date of Birth:

Corrective Eyewear Used: Glasses Contacts None

If student has any medical conditions requiring medications, please specify:

Parent's Name:

Address:

City, State, Zip:

Home Phone:

Work Phone:

Cell Phone 1 & Owner:

Cell Phone 2 & Owner:

Contact to speak with for scheduling purposes and best time to call (ie. mother after 5pm weekdays)

E-mail Address:

Course Period Desired:

Please list days of week student is available and exact times of availability:

How you were referred to us: Friend Newspaper Web Site
Brochure Search Engine Other

Please use this space to add any additional info such as study halls available, second preferences, etc., that will help us:

Regulated by: Secretary of State, BMV - Driver Education Program, 207-624-9000 ext. 52128