Youth Driver Training / Certification Program Application

Applicant Information

Applicant Name *

Applicant Age *

Applicant Address

Address Line 1

Address Line 2

City

State

Zip Code

EDGE&TA Branch #

Applicant Phone

Test 1

Instructor *

Test Result *

Pass
Fail

Test 2

Instructor *

Test Result *

Pass
Fail

Test 3

Instructor *

Test Result *

Pass
Fail

Test 4

Instructor *

Test Result *

Pass
Fail

Approved for Parade Tractor Pull

Make & Model of Tractor *

If the youth qualifies on more than -1- tractor, add them to list.

I understand my child will be operating a tractor/motorized vehicle at EDGE&TA shows and parades and will be responsible for his/her activities.

Parent or Sponsor Signature *

Parent or Sponsor Printed Name *

Safety Officer Name *

Safety Officer Email *

Mail the card to

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

EDGE&TA Branch #

Submittor Information

Submittor Name *

Submittor Position *

Submittor Email *

Website

(All cards will be mailed to the return address unless requested otherwise). Revised: August 7, 2014

Mail form to:
John Roderick
506 Cooper Court
Nevada, TX 75173

Phone: (214) 914-0915
E-mail: [email protected]