DDA License Test Registration Form© Once your registration form is submitted, a DDA Representative will contact you to schedule and coordinate the parallel parking Prep lesson and/or the License Test itself. Payment is required to schedule your test date, so please let us know what payment method you prefer below. Student InformationFirst NameLast NameGenderSelect OneMaleFemaleAgeAddress Street Address Apt / Floor City ZIP / Postal Code Home PhoneCell PhoneWork PhoneEmail DOB Date Format: MM slash DD slash YYYY So Far I've Driven Abouthours behind the wheel with othersDrive StyleSelect oneNervousScaredAverageConfidentToo ConfidentSpecial Needs/LDDriving Anxiety/PhobiaI Usually PracticeSelect oneWith a FriendWith FamilyWith SpouseNot LikelyAlt Contact InformationAlt NameRelationshipAlt Home PhoneAlt Cell PhoneAlt Work PhoneAlt Email Permit/DMV Test InformationDriver ID # on PA Permit- Starts with # 3Required if testing with DDA (8 digits)Issue Date on PA Permit Date Format: MM slash DD slash YYYY Required if testing with DDAExpiration Date on Pa Permit* Date Format: MM slash DD slash YYYY Required if testing with DDAEligibility Date on PA Permit Date Format: MM slash DD slash YYYY Required if under age 18DMV Testing HistorySelect oneI have never tested beforeI have tested before-Enter# of attempts below# of Previous Test AttemptsDriving School HistorySelect oneI have never gone to a driving schoolI no longer go to a driving schoolI still go to a driving school, but not DDA-enter school name belowDriving School NameDriving School Hours So FarSelect one1 Hour2 Hours3 Hours4 Hours5 Hours6 Hours7 Hours8 Hours9 Hours10 HoursMore than 10 Hours Approximate not exactVehicle I'll Use on Test DaySelect oneI plan on using my own vehicleI plan on using a DDA carI plan on using another driving school's carLesson PreferencesBest TimeSelect oneMorningAfternoonEveningNo PreferenceNext AvailableBest DaySelect oneWeekdayWeekendsNo PreferenceNext AvailableScheduling CommentsDDA Program InformationProgram RequestedSelect OneTest Only SaleQuick Test, Prep & Car Sale SaleExpress Parallel Parking SalePayment OptionsSelect One* * l'll Pay Online-Credit Card, Debit Card or PaypalI"ll Pay with a Money Order**PMT Req'd to Schedule Tests or Lessons You are required to print and save a copy of your receipt to show your Coach or Tester before each driving lesson or test can begin. Payments will not be accepted the day of test or lesson. TIP: Keep your receipt with your PA PermitOther InformationA DDA Rep ShouldSelect OneCall me-I need infoSend dates-I already spoke to DDAGot info and lesson date-here's my Reg formBest Phone # to CallReferred bySelect OneLearn to DrivePennDOT websiteFriendFamilyAnother ParentAt High SchoolMy Insurance AgentDoctor/PediatricianOnlineGoogleSaw SignSaw Sign on top of the CarSaw CarPhonebookTaught SiblingDDA CoachDDA PenDDA MagnetDDA Biz CardDDA Bumper DecalDDA 30 Hr Class TeacherOther 30 Hr Class TeacherNewspaperI Filled Out This Reg Form UsingSelect OneIE-Internet ExplorerMozilla FirefoxApple SafariOtherAny Driving, Learning or Med Comments or Concerns Can Be Typed Here I have read and agree to DDA's Cancellation Policy/TermsDDA Cancellation Policy/terms: Behind-the-Wheel Driving lessons and Test dates are not ongoing (like work, school, etc.), but rather, a very limited educational/business commitment that should be prioritized above your other re-occurring activities, practice or jobs. When a student cancels an appointment with short notice, DDA Coaches must still be paid, so please provide us with as much notice as possible. Same-day cancellations are subject to a $40 fee. No-shows are subject to the full cost of the lesson or test and will only be rescheduled with approval from the program Director. To cancel an appointment with less than 24 hrs notice or if it's after 12pm on a Friday (for weekend cancellations) DO NOT SEND AN EMAIL! Please call 610 353-2047 and press option 2. Sending an email in this situation might not be received, therefore, the aforementioned cancellation fees will be assessed. Additionally, repeat cancellations, inappropriate or offensive behavior, voicemails or emails by parents or students will not be tolerated and DDA Inc. reserves the right to dismiss students at anytime without a refund if necessary. DDA will also share or send emails about weather alerts, scheduling future lessons, teen driving research studies, teen auto insurance discounts, and future DDA license testing updates or PennDOTchanges. I have read and understand that DDA Coaches will require all Students to wear sneakers or shoes with a back before lessons can beginDDA Flip-flop/sandal Alert: It's that time of year again. Flip-flops and sandals force the entire foot to leave the floor when braking, which immediately compromises vehicle control-ability and increases risk. If you have noticed a relapse of more abrupt stops or late braking, especially downhill or when the light changes suddenly, or moving right turns that seem too fast or wide, then move the seat closer and do not drive with backless shoes, sandals or flip-flops. Bad habits, once repeated, become more difficult to reverse, and yes, you probably would never have noticed, but that's why you called us. Excellence truly requires a Coach. Enjoy the Weather!!! ~Your friends at DDA IncPhoneThis field is for validation purposes and should be left unchanged.