Consent For Virginia Driver'S License Learner'S Permit Knowledge Examination - Virginia
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1Virginia Driver Training - Remote Testing Program
DTS 41 (02/18/2015)
CONSENT FOR VIRGINIA DRIVER'S LICENSE
LEARNER'S PERMIT KNOWLEDGE EXAMINATION
Purpose:
Use this form to grant consent for a Virginia high school student to take a Virginia Driver's License Learner's
Permit Knowledge Examination at school.
Instructions:
The student's parent/guardian must complete this form. The completed form must be submitted to the
Proctor that administers the examination.
STUDENT INFORMATION
STUDENT FULL LEGAL NAME (print) (last)
(first)
(middle)
(suffix)
BIRTH DATE (mm/dd/yyyy)
STREET ADDRESS
CITY
STATE
ZIPCODE
REMOTE TESTING CONFIRMATION NUMBER
PARENT/GUARDIAN SIGNATURE
By signing this form, I grant consent for my child to complete a knowledge examination for a Virginia learner's permit at my
child's high school as part of the Virginia Driver Training Remote Testing Program. I understand that this consent is separate
from and in addition to any authorizations required by law for the issuance of a learner's permit and/or driver's license to my
child.
PARENT/GUARDIAN NAME (print)
PARENT/GUARDIAN SIGNATURE
DATE (mm/dd/yyyy)
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