Teen Driver Inc. Driver Registration Form

COST $325

  • OGDN – Class will be held in the Ogden High School auditorium
 (Check session you would like to attend)


Dates Class Times
(Fall Semester 16-2017 School Year)
OGDN-9 Tue/Thu: 09/06/16 – 10/06/16

5:30 – 8:30 PM

(Spring Semester 16-2017 School Year)
OGDN-10 Tue/Thu: 02/14/17 – 03/16/17

5:30 – 8:30 PM

(Summer 2017)
OGDN-11 Mon-Fri: 05/31/17 – 06/13/17 7:00-10:00 AM
Summer drive times may continue for up to two weeks after last class.

Page 1 of 1

Office Use Only

Date: _________________
Check #: ______________
Amount: ______________


Do you qualify for fee waiver?

Check one; please attach waiver
form from school district for proof.

Please return this form along with the $125.00 registration fee to: Teen Driver Inc., PO Box 55, Runnells, IA 50237.
The remainder of the fee ($200) is due at the first class.
Students that qualify for full fee waiver verified by the Ogden Community School District need to send no money with form, all fees are paid by the district. Students that qualify for partial fee waiver verified by the Ogden Community School District send the deposit with this registration form with balance ($75) due at first class. Under comments above check if you qualify for full or partial fee waiver at the Ogden Community School District. Out of district cost is $340 follow instructions above for payment. Please call us at (515) 729-3414 for more information, questions or concerns. Please note your class dates and times on your calendar. Confirmation will be made by email, phone or post card one week prior to class start date. No refunds after first class session.

(Please print complete name and physical street address clearly. This information will be used to type up your certificates)
Student Information                            Email Address  
First Middle Last
City  State Zip
DOB   Phone School attended this year

Parent/Guardian Information
Name Home Phone
Address Work Phone
City Zip

In Case of Emergency Contact
Name Phone
Preferred Hospital
Doctor Phone
Does the student have any physical or learning disabilities or a current IEP, 504 plan,
or a language barrier that may require special accommodations as part of their education program?
Yes No If yes, please explain on back of page.

  Print this page