Excel Driving School Pre-register Page

This form/information may be submitted below or by phone/voice mail or mailed to the following address:

12 Martinsburg Road

Mount Vernon, Ohio 43050

(740) 393-3234

(740) 967-0628

(740) 892-2101

Student's Full Name (as it appears on record of birth):

Student's Street Address:

PO Box/Mailing Address (if different):

City, County, State Zip:

Email Address:

Parent's Name:

Home Phone:

Parent's Cell Number:

Student's Cell:

Date of First Class Session MM/DD (see class schedules):

Classroom Location:

Approximate Number of Hours Student has Driven (0-50 hours):

Student's Date of Birth (MM/DD/YYYY):

Age:

High School: