EZ Street ® Driving School
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For us to be able to fill out the DMV certificates correctly and mail it to you, please fill in
all the information on the Enrollment Form below completely prior to submit. Thank you.

Student Information   [* fields are required.]
First Name: *
Last Name: *
Birthday: *
Address: *
City / State / Zip: *
Home Phone: Example typed: 123-456-7890 *
Cell Phone: Example typed: 123-456-7890
Student Account used to Login/Logout
Your Email: *
Choose a Password: *
Re-type Password: *
Parent/Guardian Information
(required if you're under 18, optional if you are 18 or over)
First Name: *
Last Name: *
Email: *
I read, understand and agree to the terms and conditions of the EZ Street and DMV disclaimer.
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