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 Commitment Form
As an alternative to filling out this form online, you can download the PDF Version and simply print it and return it to your school's representative.

We (student) and (parent) agree to participate in the SMARTDRIVE program presented by Delmarva Broadcasting Company, in which our school is participating.

We understand that SMARTDRIVE is intended to improve the driving skills of its participants through reinforcement of driving lessons taught through Delaware's Driver Education Program, and the introduction of additional driving and decision making information to participants.

We understand that we must complete the entire program, including all three (3) instructional modules, in accordance with the established time frames in order to qualify for final prizes and to be invited to the year-end concert.

We understand that Delmarva Broadcasting Company makes no guarantees, either actual or implicit, that every participant will acquire more driving skill upon completion of this course. Furthermore, we indemnify Delmarva Broadcasting Company and all other entities associated with the presentation of this program and hold them harmless from any damages, including physical injury, death or property damage, resulting from the construction and presentation of the SMARTDRIVE program.

By checking the box below labled "We Agree to the Terms and Conditions above", we agree to all terms above and any other general or specific terms that may be presented from time to time in the conduct of the SMARTDRIVE program. We acknowledge that we have read and understood this and all other SMARTDRIVE literature made available to us and that we agree to all terms and conditions of participation.

We Agree to the Terms and Conditions above

Student Information
School:
E-Mail Address:
Password:
Secret Question:
Answer to Secret Question:
First Name:
Last Name:
Address:
 
City:
State:
Zip Code:
Phone Number:
Grade:
Birthday:
Driver's License Number: (REQUIRED FOR DE AND MD)
License Plate Number
(Primary Vehicle):		 (REQUIRED FOR MD)
License Plate Number
(Secondary Vehicle):		 (REQUIRED FOR MD)
I (student) attest that I am the driver eligible for the insurance discount provided under Delaware Defensive Driving Course Regulation 607. I am the driver completing this Defensive Driving Course and understand that any falsification of this electronic affadavit is a crime. (REQUIRED FOR DE)
Parent Information
E-Mail Address:
First Name:
Last Name:
Address:
 
City:
State:
Zip Code:
Phone Number:
 
Enter the text in the image:
 

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