NAME _________________________________________________________________ AGE ________ DATE OF BIRTH _______________ ADDRESS _____________________________________ CITY __________________ STATE ___________________ ZIP _____________ NAME YOU WOULD LIKE ON CERTIFICATE __________________________________ PHONE NUMBER HOME ( ) ______________ WORK ( ) ____________ OCCUPATION _____________ NO. OF YEARS OF COMPLETED EDUCATION ________ HAVE YOU EVER DRIVEN A RACE CAR BEFORE? YES ___ NO ___ IF YES, WHERE & WHEN _________________________________________________ HOW DID YOU FIND OUT ABOUT US? _______________________________________ GENERAL HEALTH __ GOOD __ FAIR __ POOR HEIGHT ____ WEIGHT ____ DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT WOULD OR COULD AFFECT YOUR PARTICIPATION IN THIS SCHOOL? IF YES, PLEASE DESCRIBE. _________ _______________________________________________________________________
Fee includes: School attendance, use of driver safety suit, gloves, arm restraints, helmet, soft drinks, Certificate of Completion, and a T-shirt. Fee DOES NOT include travel expenses or motel accomodations.
Damage deposit should be in the form of a separate check or cash which will be returned at the end of the School Day if there is no damage to the race car attributable to the negligence of the school participant. Normal mechanical car failure will not be considered the fault of the school participant. (NOTE: Damage deposit is not required until the day of your school. DO NOT SEND DAMAGE DEPOSIT IN ADVANCE.)
Make checks payable to...OUTLAW DRIVING SCHOOL...and mail to: OUTLAW DRIVING SCHOOL, P.O. Box 210739, Dallas, TX 75211
Please fill in your school date preference below. Every effort will be made to schedule your school at your convenience. Upon receipt of this application and your check, we will contact you to confirm your reservation.
Jan ____ Feb ____ Mar ____ Apr ____ May ____ Jun ____ Jul ____ Aug ____ Sep ____ Oct ____ Nov ____ Dec ____
UPON SIGNING THIS REGISTRATION FORM, I fully understand all of the above and agree to the following.