SmartDrive Classic Enrollment Request

All Teen Driver requests for enrollment in the SmartDrive Classic online defensive driving program require permission from your Parent/Guardian/Sponsor. Your Parent/Guardian/Sponsor must provide information including your Driver's License information that SmartDrive considers sensitive - and to meet the requirements of the Children's Internet Protection Act. Once you complete this form - a notice will be sent to your Parent/Guardian/Sponsor by email asking for your driver's license information and their permission for you to enroll in this program. If your Parent/Guardian/Sponsor does not have access to email - please contact SmartDrive by email - classic@smartdriveusa.org - or phone 888-553-6543 to make alternate enrollment arrangements.

Student Name (EXACTLY as it appears on your state issued driver license)*

First Middle Last Sr, Jr, II, II, IV etc

Student Email*

IMPORTANT!- If possible, please do not use a student email address provided by your school. Some schools block email from outside senders.

Enter Email Confirm Email

Student Mobile Phone (for Text/SMS Notifications) OPTIONAL

Your High School - Select by State*

Please Select Delaware High School*

Please Select Maryland High School*

Please Select Pennsylvania High School*

Name of Parent/Guardian/Sponsor*

Name of Parent/Guardian/Sponsor who will provide permission for your enrollment in SmartDrive Classic. If your Parent/Guardian/Sponsor does not have an e-mail address - please call SmartDrive at during business hours at 888.553.6543 (8A-5P) and leave a message with your contact information.

First Last

Email of Parent/Guardian/Sponsor who will provide permission for your enrollment.*

IMPORTANT NOTICE: The email address your provide for your Parent/Guardian/Sponsor cannot be the same as the student email address.

Enter Email Confirm Email

Parent Mobile Telephone Number*

Please provide the mobile telephone number of Parent/Guardian/Sponsor should contact be required as part of the enrollment process. This number cannot be the same as the student's phone number.

Comments

This field is for validation purposes and should be left unchanged.

Saving Lives through Defensive Driving and Highway Safety Programs for Teen Drivers

SDC Enrollment Request