Orange County Sheriff's Office > Public Interest > Youth Opportunities > Teen Driver Challenge

Class Date

Date:

Student Information
Student First Name:	Student Last Name:

Student Middle Name:	Student Preferred Name:

School/Academy Attend:

Date of Birth:	Age during class date:

Mailing Address:

Student Phone Number:	Studetn Email:

Learner's Permit/Driver's License Number:

Select your license type:

Number of months practiced driving on actual roads (at least 6 months to be considered):

Are you taking any medication that may affect your ability to operate a vehicle?
Select a shirt size:

Parent/Guardian Information Full Name:

Phone Number:	Email: