Get Out Alive - The Parent-Teen Driving Challenge Registration

Please fill out the form below, click the "Print" button to print it out and mail it or fax it to the address/number below. If you have any problems with this form, please click here to contact Rayette.

Click here for event details.

* STUDENTS PARTICIPATING MUST HOLD A VALID MAINE DRIVER’S PERMIT OR LICENSE, HAVE WRITTEN PARENTAL PERMISSION, INCLUDE THE PARTICIPANT RELEASE AND ASSUMPTION OF RISK AGREEMENT SIGNED BY BOTH STUDENT AND PARENT. CLICK HERE TO DOWNLOAD THE RELEASE AND ASSUMPTION OF RISK AGREEMENT.

Please note: Fields with an " * " are required.

Student Information

Date
* Student Name
* Address
* City/Town
* State	* Zip Code
* Phone No.
* Email
* Name of School Representing
* Class	A B C D N/A
My Maine Driver's Permit No. is
My Maine Driver's License No. is

Parent Information

* Parent Name
* Address
* City/Town
* State	* Zip Code
* Phone No.

Authorization

Parent We have read the participant rules, signed the participant release and assumption of risk agreement and give our student permission to enter the Get Out Alive Driving Challenge on May 17. 2008.

Parent Signature

Student I have read the participant rules, signed the participant release and assumption of risk agreement and wish to enter the Get Out Alive Driving Challenge on May 17. 2008

Student Signature

Get Out Alive
AAA NNE
PO Box 3544
Portland. ME 04104
Fax: 207-791-8589