Orange County Sheriff's Office > Public Interest > Youth Opportunities > Teen Driver Challenge

Class Date

Date:

Student Information
Student First Name:	Student Last Name:
*	*
Student Middle Name:	Student Preferred Name:
	*
School/Academy Attend:
*
Date of Birth:	Age during class date:
* *	* *
Mailing Address:
* * * *
Student Phone Number:	Studetn Email:
*	* *
Learner's Permit/Driver's License Number:
*
Select your license type:
*
Number of months practiced driving on actual roads (at least 6 months to be considered):
* *
Are you taking any medication that may affect your ability to operate a vehicle?
Select a shirt size:
*
Parent/Guardian Information Full Name:
*
Phone Number:	Email:
*	* *