To register for behind-the-lessons only, please complete the form below.

Refund policy: Registrations that are cancelled prior to the first behind-the-wheel lesson will be refunded less a $10 fee for credit card processing. Behind-the-wheel lessons are subject to a late cancellation fee of $75 if cancelled less than 24 hours before the lesson start time (the 24 hours does not include weekends or holidays).

Student Information

* Indicates Required Field

Student First Name: *

(As it appears on student's birth certificate)

Student Middle Name: *

(As it appears on student's birth certificate. If no middle name, please type leave this field blank)

Student Last Name: *

(As it appears on student's birth certificate)

Nickname:

(optional)

Suffix:

(optional, Example "Jr." or "III" as it appears on birth certificate)

Primary Address Information

Address 1 *

Address 2

City *

State *

Zip *

Secondary Address Information

Address 1

Address 2

City

State

Zip

Home Phone:

(optional)

Student Cell Phone:

(recommended)

Student Email:

(recommended)

Birthdate: *

(mm/dd/yyyy)
Safeway's program is for teens under age 18

Gender:

(optional)

Parent/Guardian Information

Parent/Guardian (required)

First Name: *

Last Name: *

Email: *

Phone: *

Additional Parent/Guardian (optional)

First Name:

Last Name:

Email:

Phone:

Note to Instructor (optional):
(Please note any special circumstances
concerning the student)

Continue