Form Dmv-Pcf-01 - Parental Consent Form To Obtain A Learner Permit
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1Government of the District of Columbia
Department of Motor Vehicles
Parental Consent Form to Obtain a Learner Permit
Applicant Full Name
Date of Birth
Sex
Social Security #
(First, Middle, Last, Suffix)
Male
Female
DC Address
City, State
Zip Code
Telephone #
Washington, DC
Parent
*If Legal guardian, provide court decree number:
Relationship to Applicant (Check one)
Legal Guardian
*
Full Name of Parent or Legal Guardian
Date of Birth
Sex
Telephone #
(First, Middle, Last, Suffix)
Male
Female
Address
City, State
Zip Code
Washington, DC
DC Driver License or Identification Card Number
Expiration Date
Email Address
Parental/Legal Guardianship Verification
One of the following documents is required depending on your relationship to the applicant
Parent
Legal Guardian
Full birth certificate of applicant or adoption court order
Guardianship decree
reflecting parent’s name
Any person using a fictitious name or address and knowingly making any false statement on this application is in violation of DC Law and subject
to a fine of not more than $1,000 or 180 days imprisonment or both. (D.C. Official Code §22-2405)
I hereby certify that the information provided on this document is true and accurate to the best of my knowledge and belief.
Signature of Parent/Legal Guardian:_______________________________________________________Date:________________________________
For DMV Official Use Only
DMV Examiner’s Signature:__________________________________________________________Date:________________________________
If you have questions, please visit our website, , or call 311 in DC or 202-737-4404 outside the 202 area code.
To confidentially report waste, fraud or abuse by any DC Government Agency or official, call the DC Inspector General at 1-800-521-1639.
DMV-PCF-01 Rev.7/2015
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