Appointment Request Form Choose Your Service* Driving Lessons Driver's Education Class Driving Simulator Partially Sighted Drivers Traffic Safety School DUI Class Have you used Safe Driving School?* New client Returning Preferred Date/Times*Name* First Last Age*Please enter a number from 15 to 99.Birthday* MM slash DD slash YYYY Do You Have A Permit?* Yes No Special Needs (If Applicable)Upload a Copy of PermitMax. file size: 31 MB.Do You Have Driving Experience?* Yes No Phone*Best Time to be Reached for Confirmation* : Hours Minutes AM PM AM/PM Email* EmailThis field is for validation purposes and should be left unchanged.