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.

1. The Registration Fee is non-refundable. In the event of inclement weather or mechanical failure of the car, I will be rescheduled for another school. OUTLAW DRIVING SCHOOL is not responsible for my travel or living expenses to return for another school.
2. I will be required to sign a standard insurance release form on the day of the school and before the school begins.
3. I fully understand that non-prescribed drugs and/or alcoholic beverages will NOT be allowed by OUTLAW DRIVING SCHOOL before or during the actual school.

DATE ____________________
SIGNATURE _____________________________________________________