Editing previous response:

Please fix the highlighted areas below before submitting.

Student Driver Application

Student Driver First and Last Name:*

Answer Required

Driver's License ID Number:*

Answer Required

Birth Date:*

Answer Required

Insurance Company ID:*

Answer Required

Current Tag Number:*

Answer Required

Vehicle Make, Model, Year and Color:*

Answer Required

Parent/Guardian First and Last Name:*

Answer Required

Parent Phone Number:*

Answer Required

I agree to follow traffic rules and regulations on campus.

I agree to follow speed limits within the school zones and on school campus

I understand I must not leave campus without checking out with the front office

I understand I must park in my assigned parking space

I agree to have my student decal in my car while on campus

I agree to follow dismissal guidelines for student dirvers

I agree to practice safety precaustions when entering and exiting campus to insure the safety of everyone on campus.

I agree to attend the Bemont Student Driver Meeting or revoke my privilege of driving on campus

Student Signature:*

Answer Required

Please list Belmont Students who have permission to ride with your student driver below. Include siblings. If a student riding with the driver is not a sibling we must have written permission from that student's parent to ride with the driver.*

Answer Required

Parent Signature:*

Answer Required