44 Spring Street                                                   manager@drivingschoolsma.com

         Watertown, MA  02472                                                 (617) 393-1700

DRIVER ATTITUDINAL RETRAINING COURSE "Safety First"
REGISTRATION FORM

  Student's Last Name ________________________________ First Name __________________________

  Date of Birth _____________________________ Who Referred You? _____________________________

  Full Address __________________________________________________________________________ 

  Home Phone _______________     Cell Phone ________________  E-Mail _________________________

  Reason for taking Course: __________________________________________________________________

  License Number ___________________________________ Issue Date  _____________________________ 
 

Request to take "Safety First" Course

      I, _______________________________________(please print your name),  hereby request to be enrolled in your state-approved Driver Attitudinal Retraining Course provided by Bay State Driving School.  

     That I, _____________________________________(please print name) with this Registration Form am submitting full payment of $60.00 to reserve my space to attend the 4-hour classroom session. That I am also enclosing copy of my driver's license, and copy of the letter of the agency who is requiring this course.  Check mark next to the date you will be attending:

___  Sat. July 31st at 1:00 p.m.       .                  Note:  Sessions will be held at 372 Main St. in Watertown. 

___  Sat. Aug. 28th at 1:00 p.m.                                     You must pre-register before you attend.

___  Sat. Oct. 2nd at 2:00 p.m.                                      Print this form, fill it out, and mail it to us with check or money
___  Sat. Nov. 6th at 2:00 p.m.                                   order for the amount of $60.00. Also send a copy of your

___  Sat. Dec. 4th at 2:00 p.m.                                     driver's license, and copy of letter from the courts or RMV.

Depending on the number of registrants, we may be able to provide other alternative dates and times for your convenience.  We must receive all forms and payment at least 1 week before the class.                                 

Please send a copy of the violation and letter stating the need to take this course and a copy of your driver's license.  Return this registration form along with payment to reserve your seat.

*** Upon receipt of this registration form and other required documents, the office will contact you by phone confirming enrollment to the "Safety First" Course.   We must receive all required items listed above at least 7 days before desired class.  You will not be issued a letter of completion if we do not have all documents on file.

SIGNATURE ______________________________________________________________________________

DATE ____________________________________________