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Teen Driver Challenge
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Teen Driver Challenge Contact Information
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Steps
1.
Student Information
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2.
Parent/Guardian Information
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Student Information
Student Name
*
Date of Birth
*
Date of Birth
Age
*
Place of Birth
*
Student Email
School Attending
*
Grade
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Shirt Size
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Parent/Guardian Information
Parent/Guardian Name
*
Phone Number
*
Email Address
*
Address
*
City
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State
*
Zip Code
*
Are there any health issues we should be aware of?
Is any medication being taken that will in any way effect the safe operation of a vehicle?
I have been informed that my child's full name, address, date of birth, email address, school attending, parent's email address and driver's license number will be released to the Florida Sheriff's Association Teen Driver Challenge upon request. I hereby give consent for the above-named student to participate in the FSA Teen Driver Challenge offered by the St. Lucie County Sheriff's Office. I state this consent is given with the understanding that:
The training course involves moving vehicles being operated by inexperienced drivers.
The named student will be operating a vehicle with the express written consent of the owner of the vehicle.
Damage may occur to the vehicle that the above-named student is driving or to other vehicles involved in the course.
The above-named student's participation in this course subjects the student to a risk of serious, catastrophic, permanent injury or even death.
If I am not the owner of the vehicle which the above-named student intends to use while taking this course, I hereby certify that the owner has consented to the use of his or her vehicle and has authorized the use by completing the
vehicle owner's statement of permission and release of all claims
form and I have provided it with this registration.
I certify that the vehicle which the above-named student will use in this course is in good working order, including the vehicle's engine, brakes, suspension, steering and tires.
I hereby release and agree to hold harmless from liability for any and all claims, demands, damages, actions, causes of action, including acts of negligence, or suits in equity of whatsoever kind of nature, the St. Lucie County Board of County Commissioners, the office of the Sheriff, St. Lucie County, Florida, their officers, employees, instructors, agents or apparent agents and other participants in the course.
I give permission to the St. Lucie County Sheriff's Office to use photographs and/or video images of my child for media coverage, or for any other use deemed appropriate by the Sheriff.
I agree/consent
*
Yes
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