*
Required
Driver Information
First Name
*
required
Last Name
*
required
Address Line 1
*
required
Address Line 2
City
*
required
State
*
required
Zip
*
required
Email
*
required
Please use lowercase letters only.
Phone
*
required
Please use numbers only; no special characters.
For what Canterbury School divisions are you interested in driving?*
Early Childhood
Lower School
Middle School
High School
Insurance Information
Auto Insurance Company
*
required
Policy Number
*
required
Driver's License Number
*
required
Driver's License Expiration Date
*
required
By completing this form with my electronic signature, I attest to the fact that I hold a driver's license in good standing. This form is valid for the 2020-21 school year.
*
required
Please include your first and last name, to be used as your electronic signature.
Type first and last name
Please send a confirmation email to the address below*: