Phoenix - Groupon Registration Form

Groupon Voucher Holders
Thank you for registering for our life saving
Car Control & Collision Avoidance Driving Clinic.
Please remember:

Once scheduled, YOUR PROGRAM FEE IS NON REFUNDABLE. A $50 fee will be collected BEFORE you can be allowed to reschedule to a later date.

  1. A parent or guardian must sign the Minor Consent Form and Minor Liability Waiver forms if you are under 18 years of age. For participants 18 years of age or older please complete the Adult Liability Waiver Form.
  2. You must bring a valid, state or federally issued photo I.D. with you (drivers license, etc.).
  3. You must put a valid Groupon voucher number (the one with letters in the code) into the registration field or pay the higher, but still discounted $199 to attend.
  4. Once your registration is submitted, you'll be sent an email confirming your registration. If you don't see it in your in-box, check your SPAM FOLDER.
  5. A reminder email will be sent to you about 7 days ahead of your scheduled program date.
    NOTE: Failure to show up without providing advance notice will result in 100% forfeiture of your payment. NO EXCEPTIONS for any reason.

    We look forward to seeing you!

  Registration Form

* Required Fields
Program Date: * Please only choose one program date.
First Name: *
Last Name: *
Date of birth (mm/dd/yyyy):* / /
High School Currently Attending?
Do you have a valid license or permit?* YesNo
Parent Email Address: (if under 18 years old)
Some users may find their confirmation emails in their SPAM folders.
Student Email Address:*
Some users may find their confirmation emails in their SPAM folders.
Phone Number:* ()- -
Address: *
Address 2:
State: *
Zip Code:*
Have you had a crash as a driver? Yes No
Are there any other teenage drivers in your family? Yes No

Please add to your safe senders list. Check your spam folder for your confirmation if you don't receive it.