Registration

1. Full Name

2. Phone Number

3. Email

4. Home Address

5. City

6. Date of Birth

7. Desired Date: 08/10/202408/24/202409/14/202409/28/202410/12/202410/26/202411/09/202411/23/202412/07/202412/21/2024

8. International Student (K.U.): YESNO

9. Home Pick-up (K.U.International Student Only): YESNO

10. Does the student have an IEP? YesNo

11. Would you like to purchase a $11.00 Student Driver magnet?
    

    This magnet can be put on your car while practicing with your child to help others be aware that the driver is a learning student.

    YesNo

12. Promo Code:

Parents - please acknowledge the following: (Adult students may skip this portion)

13. Kansas law states: Teenagers must obtain 50 hours of supervised driving. Guardians acknowledge they will help the student practice (for teenagers only) Yes

14. Kansas law states: Teenagers must hold a picture permit for 1 year to obtain a restricted license.I understand.

15. After the theory class teenagers are sent home with a pink permit. Guardians acknowledge that teenagers who are first time permit holders must exchange pink permit for a picture permit at the DMV (no testing at the DMV). I understand.

Students - please acknowldege the following:

16. Student acknowledges they must contact BuckleUp School or their instructor to make driving appointments after completing the classroom theory but before expired date. I understand.

For additional information please visit the Resources page of our webite.