ADVANCED DRIVING ACADEMY
830 Fairway Trail, Hernando, MS 38632
Phone: 866-429-2163 Fax: 662-429-5767

COURT SIGN-UP FORM

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Court: Date:

First Name: Mid. Initial: Last Name:

Date Of Birth: D. L. #: State:

Address: City:

State: Zip Code:

Phone #:

Now that you have court permission, please go to the following website: www.4driving.com and click on "Classroom Registration". Please fill out the sign-up form and print out a registration acknowledgement form and bring to class with you. If you encounter any problems, please call: 1-866-429-2163.