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Package Name	Package Description	Price	Select
Defensive Driving Course 4hrs	-The stages, causes and prevention of collisions. -How to reduce collision risk with defensive driving strategies -How driving distractions such as talking and texting affect driving ability -The definition of impairment and its related dangers -The impact of physical, weather, road and traffic conditions -How to identify and minimize aggressive driving activities -The four fata driving behaviors	$100.00
Defensive Driving Course 6/8 hours	- Six/Eight hour course - Practical knowledge and techniques to avoid collisions and violations - Sensible advice for choosing safe, responsible, and lawful driving behaviors and habits -Guidance for coaching your employees to view safety on a personal level - Skills for recognizing how attitude can help prevent accidents and poor decision making *Spanish available	$100.00

Student Information
First Name:	*	Gender:	*
Middle Name:		High School(Teen Only):
Last Name:	*	Drivers License/Permit Number:
Address:	*	Drivers License/Permit Issued Date:
City:	*	Drivers License/Pemit Expiration Date:
State and Zip:	*	Parent/Guardian Name 1 (Teen Only):
Date Of Birth:	*	Parent/Guardian Phone 1 (Teen Only):
Student Email:	*	Parent/Guardian Email 1 (Teen Only):
Home Phone:		Parent/Guardian Name 2 (Teen Only):
Student Cell Phone:	*	Parent/Guardian Phone 2 (Teen Only):
Wear Glasses/Contacts:		Parent/Guardian Email 2 (Teen Only):
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