LifeSpring Academy Fall 2022 Class RegistrationPlease enable JavaScript in your browser to complete this form.Classes are open to all LifeSpring Academy students ages at least 14 1/2 years old by the first day of class. Classes will be held at LifeSpring Academy at 4967 US-70 BUS, Clayton, NC 27520. Class Dates are as follows: November 7-10 2:30-5:30 PM, November 14-17 2:30-5:30 PM, November 18 8:00 AM-2:00 PM. Registration is $500 for Fall 2022. The registration fee includes 30 hrs of classroom instruction and 6 hrs Behind-the-Wheel Instruction. A minimum $100 deposit at the time of registration is required to hold a spot in the class. The remaining balance is due 14 days before the first day of class. Behind-the-Wheel Instruction will take place at a time agreed upon by parent and a Benson Driving School instructor. Behind-the-Wheel Instruction will take place in 3 sessions of 2 hours each. Benson Driving School will provide a licensed instructor and an approved dual-controlled vehicle for instruction. Today's Date *Student Name *FirstMiddleLast(As it appears on birth certificate)Student's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStudent's Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's Phone # *Student's Email *Student's School *Current Grade *8th Grade9th Grade10th Grade11th Grade12th GradeGraduatedGuardian Information will be used for billing and scheduling. Please enter an email address that you check often. Guardian's Name *FirstLastGuardian's Phone # *This phone number will be used to schedule student's driving times and dates.Guardian's Email *This email address will be used to send an invoice (payable online) to complete the student's registration.Checkboxes *I agree to the polices listed on the Policies PageNotes(Optional)Submit For more information, call Benson Driving School at (919) 802-6072