Kajun Lanes Driving Academy

LLC

38 Hour Driver Education Registration Classes are held at Hampton Inn & Suite in Marksville Healthcare Professionals teaching the youth of central Louisiana the importance of safe and defensive driving. Louisiana State Certified Driving School

Name:(Print as it appears on birth certificate)_________________________________________________ DOB:_______________Age: _________ School________________________________

(Needed for Permit)

Sex:____ Eye Color:_____ Height ______ Weight______ Hair Color______

Address:(list PO Box and Physical address) _________________________________________________ __________________________________________________________________ Phone :(Home)__________________________Student Cell___________________________ (Parent)Name:___________________________Parent Cell # _____________________ Email Address:__________________________________________________________ How did you hear about us: Newspaper
DMV Friend_________________________________

Facebook (visit us on Facebook at: Kajun LanesDriving Academy

$100 deposit is required to reserve seating: Please Make Deposit payable to: Kathy Daigrepont Mail to : Kajun Lanes Driving Academy PO Box 855 Marksville, La. 71351 Check Box to indicate which class dates you are registering for:

January 4,5,11,12 2014

March 2014 call for dates

Call For Future class dates

For more information Call or Email: Kajunlanesdrivingacademy@gmail.com

Kathy Daigrepont 318-305-0599

Kim Daigrepont 318-201-7551

DRIVING SCHOOL TEMPORARY INSTRUCTION PERMIT

Louisiana Department of Public Safety and Corrections School Name and License # Office of Motor Vehicles

Please return this page with your Registration. All of the following information is needed on your Temporary Instruction Permit which allows Kajun Lanes Driving Academy to provide driver training for your child.

Student Name:__________________________________________________
Date of Birth Sex Eye Color Height Weight Hair Color Restrictions

/ /
1. Have you ever experienced any loss of consciousness other than normal Yes No sleep? If yes, explain: 2. Do you have any physical condition such as epilepsy, diabetes, heart trouble, paralysis, fainting spells, dizzy spells, or other type of condition Yes No which could impair your ability to operate a motor vehicle safely? 3. Have you ever been diagnosed with a mental illness or do you have any condition which could impair your ability to operate a motor vehicle Yes No safely? 4. Do you wear contact lenses or glasses when driving? Yes No 5. Do you understand highway warning and direction signs in Louisiana? Yes No 6. Are you aware that a false statement in securing this permit will Yes No automatically revoke the same? A YES answer to 1, 2 or 3 requires that the applicant be referred to his/her physician for clearance prior to issuance of this instruction permit. A copy of the physicians statement and a copy of this permit must be attached to the certificate of completion I swear that the above statements are true to the best of my knowledge.
Signature of Applicant(Student) Date

Signature of Parent or Guardian

Drivers License No.

Date

Kajun Lanes Driving Academy, LLC

Class dates are: January 4, 5, 11,12 2014 Class Time: 8am-400pm Marksville, La. Hampton Inn & Suites

Registration Begins at 7:45am on first day of class. Registration requirements:

1. Please make deposit payable to Kathy Daigrepont: PO Box 855 Marksville, La. 71351. Please mail deposit along with registration and temporary instruction permit information sheet. 2. Course Fee is $325. Once your $100 deposit has been paid the balance of $225 is due on the first day of class. 3. Cash only, no checks will be accepted on first day of class.******

Classroom Requirements:
1. You must bring your Birth Certificate in on first day of class 2. Please bring your Louisiana Drivers Guide for Class D and E (Study guide). 3. Please bring ink pen and your Louisiana Drivers Study Guide to class. 4. Parents or Legal guardian must come in first day of class with student to sign forms and parent or legal guardian MUST bring their drivers license to sign up student. 5. Please bring a lunch. You will be given 30 minutes for lunch, but will not be allowed to leave. Please instruct your child that they are not allowed to cross Tunica Drive to walk to McDonalds. Kajun Lanes Driving Academy will not be responsible for your child outside of the classroom.

Study Guide:
Click on the below link to print out your Louisiana Drivers Guide for Class D /E Effective date 9/1/13. This study guide is needed for class. Each student must come with a study guide, if this is a problem let me know.
***** Hold Ctrl (key ) and click on below site to print your study guide:

http://dpsweb.dps.louisiana.gov/DPSForms.nsf/
If you are unable to download Louisiana Drivers Guide for Class D and E from the above link go to www.expresslane.org or http://omv.dps.state.la.us/ click on forms and study guide, click blue arrow to the right >License, then click on LA English Driver's Guide Class "D"/"E" Effective date 9/1/2013 download and print it may take a few minutes to download.