Please print this page, fill it out, and return it to your instructor.

Name: ____________________________________________________

Address: ____________________________________________________________________

*Social Security Number: ____________________________________

*Phone Number: ____________________________________

*Cell Phone: ____________________________________

Parent / Guardian Name: ____________________________________________________________________

Address (if different): ____________________________________________________________________

Home School: ____________________________________________________________________

Grade: ______________

Truck Position Desired: ____________________________________________________________________

Student Signature: ____________________________________________________________________

Date: ____________________________________

PARENT / GUARDIAN STATEMENT

My child has available transportation to and from events:   Yes     No

My child has medical insurance or school system's Accident Insurance:   Yes     No

Name of Insurance: ____________________________________________________________________

Parent / Guardian Name (Print Name): ____________________________________________________________________

Signature: ____________________________________________________________________

Date: ____________________________________