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Addendum to Virtual Driving Agreement Form(Please print neatly and attach when paperwork is submitted)Name: ____________________________________________________________Address: __________________________________________________________City, State, Zip: ___________________________________________________Email Address for Zoom Invite: ____________________________________Home Phone: ___________________Cell Phone: _______________________Permission to Text:Yes__________ No __________Date of Birth: ________________________________Temporary Permit #: __________________________Issue Date: ___________________ Exp. Date: _____________________ High School: _________________ Dismissal Time: __________________Please list requested Dates and Times for Virtual classes and circle am or pm:Class 1: _______________ am or pmClass 2: ________________ am or pmClass 3: _______________ am or pmClass 4: ________________ am or pmClass 5: _______________ am or pmClass 6: ________________ am or pmFinal Test: Date: ____________ Time: ___________ Location: _________________Items Attached:Signed Virtual Agreement:Yes___ No___ Payment: Yes___ No___~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Office Use Only:Zoom Invite: Yes No Paperwork: Yes No Receipt #______________ Amt: ____________Instructor:_______________________ Comp Date:_____________ Cert#_______________________ ................
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