I/We do hereby consent that________________________________________________, a minor,
                                   Last          First              Middle

date of birth  ________  has driven a minimum of 50 hours during the past twelve months, of which 10 hours of driving were at night.

______________________________________ ______________________________________ Parent or Guardian Signature Parent or Guardian Name (Printed)

State of Florida:
County of ___________________
Sworn and subscribed by me this
____day of________,20____
AFFIX     NOTARY PUBLIC OR
SEALS     D.L. EXAMINER

State of Florida:
County of ___________________
Sworn and subscribed by me this
____day of________,20____
AFFIX     NOTARY PUBLIC OR
SEALS     D.L. EXAMINER

   _______________________
   Parent or Guardian I.D.
   _______________________
                     I.D.#

Drug and Alcohol Education Course Completed on __________________________ (Examiner completes)

INSTRUCTIONS:

1. One parent or guardian must sign this form.

2. All signatures must be notarized, or witnessed by an examiner.

3. This form, social security card if you have been issued one, and birth certificate must 
   be presented to driver licenses office by all customers under 18, unless married.