Driver Education Pay Online

Making payment online means that there is Parent/Guardian Consent: The student named below has my permission to enroll and participate in the Holy Cross High School Driver and Traffic Safety Education Program. I have read and understand the information provided in the application.

Student Legal Name*

First Middle Last

Student Home Phone*

Student Cell Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

High School Currently Attending*

Student Email*

Age*

Date of Birth*

9 Digit Permit Number*

Student Signature*

Parent/Guardian Consent: The student named above has my permission to enroll and participate in the Holy Cross High School Driver and Traffic Safety Education Program. I have read and understand the information provided at the top of this form.

Parent/Guardian Name*

First Last

Relationship to Student*

Parent/Guardian Home Phone*

Parent/Guardian Cell Phone*

Parent/Guardian Email*

Parent/Guardian Signature*

Are you a Holy Cross Student?*

Yes

No

$775 for Holy Cross students*

Price:

$795 for non-Holy Cross students*

Price:

Total

Credit Card

Card Details

Cardholder Name