Register For BetterSaferDriver.com Defensive Driving Course Ventura County

Ventura County - Registration Form

A parent or guardian must sign the Minor Consent Form and Minor Liability Waiver forms if you are under 18 years of age. For participants 18 years of age or older please complete the Adult Liability Waiver Form.
You must bring a valid, state or federally issued photo I.D. with you (drivers license, etc.).
You must pre-pay for your clinic: Failure to complete any of the above steps may prevent you from participating in the driving program.
NOTE: Failure to show up without providing at least 14 days notice will result in a $20 penalty to reschedule (No exceptions). There is NO fee for rescheduling outside of 14 days.

* Required Fieldss

Program Date: *
First Name: *
Last Name: *
Age:
Date of birth (mm/dd/yyyy):*	/ /
High School Currently Attending?
Do you have a valid drivers license?*	YesNo Currently Suspended License
Parent Email Address: (if under 18 years old) AOL users may have difficulty receiving confirmation emails due to tight SPAM security measures.
Student Email Address:* AOL users may have difficulty receiving confirmation emails due to tight SPAM security measures.
Phone Number:*	()- -
Address: *
Address 2:
City:*
State: *
Zip Code:*
Court Appointed:*	Yes No
Court Case Number:
Describe your infraction:

Are there any other teenage drivers in your family?	Yes No
Promotional code (if applicable):
Comments

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