Last Name: First Name:     Grade:

Driver's License Number:

Vehicle Number 1--Primary Vehicle

Type Type Car Pickup Truck Sport Utility Make (Ford, Dodge, Chevy, etc): Model (Cherokee, etc.):

Doors: 2 4 Color: Tag No.:Name of Owner:

45 Day Tag Date of Expiration:

Vehicle Number 2

Type Type Car Pickup Truck Sport Utility Make (Ford, Dodge, Chevy, etc): Model (Cherokee, etc.):

Doors: 2 4 Color: Tag No.:Name of Owner:

Vehicle Number 3

Type Type Car Pickup Truck Sport Utility Make (Ford, Dodge, Chevy, etc): Model (Cherokee, etc.):

Doors: 2 4 Color: Tag No.:Name of Owner:

I certify that I will follow the rules for driving and parking on the Boiling Springs High School Campus; that I have a valid driver's license; and that the vehicle I operate on campus is covered by insurance as prescribed by the South Carolina Code of Laws.  I understand that driving is a privilege that can be withdrawn at anytime.

Date:_______________Student Signature:_____________________________________

Permit Number:__________________________________________________________