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PARENT-TAUGHT DRIVER EDUCATION AFFIDAVIT

By this affidavit, I(we) do hereby affirm to the Department of Public Safety that I(we),

_________________________________________________________________________________________________________ Parent 1: (Name, Date of Birth, and Mailing Address)

__________________________________________________ (Drivers License Number and State)

_________________________________________________________________________________________________________ Parent 2: (Name, Date of Birth, and Mailing Address)

__________________________________________________ (Drivers License Number and State)

have been issued and possess a valid driver license and have selected a parent-taught driver education course, as approved and certified by the Department of Public Safety, from:

_________________________________________________________________________________________________________ (Name of company providing parent-taught driver education course)

which I(we) will use to teach driver education to my(our) child:

_________________________________________________________________________________________________________

Student 1: (Name, Date of Birth, and Mailing Address)

(Instruction Permit Number or Driver License Number if applicable)

(If student name is different from the parent, send copies of documents showing why name is different.)

using the following vehicle(s):

_________________________________________________________________________________________________________

(Make, model, year)

(License plate # , expiration date)

(Insurance company, policy #, expiration date)

_________________________________________________________________________________________________________

(Make, model, year)

(License plate # , expiration date)

(Insurance company, policy #, expiration date)

I(we) do affirm that, to the best of my(our) knowledge, each vehicle listed above complies with Oklahoma law regarding registration (47 O.S. Chapter 74), insurance (47 O.S. Chapter 7), and safety and equipment requirements (47 O.S. Chapters 12 and 13).

I(we) and the student listed above fully understand and agree that (please check beside each statement):

This affidavit does not constitute authorization for the student listed above to drive in lieu of possession of a valid Oklahoma instruction permit or driver license, nor is it a substitute for insurance verification. The accepted copy of this affidavit must be carried in the vehicle during any behind-the-wheel session of parent-taught driver education and must be presented upon demand to any law enforcement officer or Department of Public Safety employee. No more than two (2) students and two (2) parent instructors shall occupy the vehicle during any behind-the-wheel session of parent-taught driver education. We will obey all state laws regarding the operation of a motor vehicle and all rules of the Department of Public Safety regarding parent-taught driver education. We will notify the Department of Public Safety immediately if any information in this affidavit changes. We hold harmless and free of liability the Department of Public Safety, its employees, and the State of Oklahoma.

Complete and mail this form to: Oklahoma Department of Public Safety Driver License Examining 3600 Martin Luther King PO Box 11415 Oklahoma City, OK 73136

_____________________________________ Signature of Parent (1)

_____________________________________ Signature of Parent (2)

_____________________________________ Signature of Student

Revised 10-3-05

(For DPS Use Only) Received: _____________

Accepted:

_______________

Accepted By: _________

Returned

_____________

AN:

___________

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