Instructions for Documentation for Madison County Sheriff Department's Distracted Teen Driving Course


Dear Parent and Student,

For you to participate in this course, you must properly complete all the attached documents and bring with you to class. We will exercise the utmost safety for all our participants. However we do need a photocopy of your health insurance card submitted with your documents. We plan to present a very educational and enjoyable course, and hope you will take that information with you for the remainder of your driving career.

We have provided forms in writeable pdf format.
Forms can be filled out on your computer and then printed for signature.

APPLICATION must be completed and emailed to dmoody@madisoncountyal.gov or turned in to your school resource officer by the Friday prior to your class and the original brought to class.)

ALL forms below MUST be brought day of class.

PERMISSION & RELEASE AGREEMENT

• Please read the entire page
• Fill-in the top line with the students name
• After reading each block, the student and parent/guardian initials in the left column.

EMERGENCY CONTACT AND MEDICAL INFORMATION

• Please complete the information.
• Attach a photo copy of your child's health insurance card.

Sgt. David Moody
Madison County Sheriff's Department
Distracted Teen Driver Course, Coordinator
dmoody@madisoncountyal.gov
256-533-8855