Select a Session :

# 5 May $445

#5 May $415 w/ Insurance Quote Discount ++

#6 June $445

#6 June $415 w/ Insurance Quote Discount ++

#7 July $445

#7 July $415 w/ Insurance Quote Discount ++

#8 August $445

#8 August $415 w/ Insurance Quote Discount ++

Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Student Cell Phone *

(###)

###

####

Permit Issue Date *

MM

DD

YYYY

Permit Expiration Date *

MM

DD

YYYY

Parent 1 Name *

First Name

Last Name

Parent 1 Cell Phone *

(###)

###

####

Parent 2 Name

First Name

Last Name

Parent 2 Cell Phone

(###)

###

####

Select Drop off & Pick Up Destination (NOTE: will pick up from school, will NOT drop back off at school. This will be discussed at Parent Mtg)

YMCA/YWCA

McDonald's on Holiday Dr.

Hardee's in Key West

McDonald on Iowa St.

Eichman's Bar and Grill

Dairy Queen in Peosta

Dubuque Driving Academy Classroom - 2327 Central Ave

How did you hear about us?

Facebook

Instagram

School

Friend/ Relative

Google Search

Repeat Family

Payment type:

Cash

Check : Made out out DBQ Driving Academy

Venmo

Credit Card (Note: Subject to a 3.5% +0.15 Service fee)

Waiver *

As Parent / Guardian of student I agree, along with my student to the posted waiver on the website

Yes

No