E Stafford CDL Training
Student Registration Form
56 Fallkill Ave, Poughkeepsie, NY 12601
845-745-3861 | staffordcdl.com
Student Information
Full Name: __________________________________________
Date of Birth: ________________________________________
Home Address: _______________________________________
City: __________________ State: ______ Zip: ____________
Phone Number: _______________________________________
Email Address: _______________________________________
Driver License Number: ________________________________
State of Issue: _______________________________________
License Expiration Date: _______________________________
Permit Type (if applicable): _____________________________
CDL Program Enrollment
Program Type:
☐ Class A CDL
☐ Class B CDL
☐ Manual Transmission Training
☐ Road Test Preparation
☐ Refresher Course
Desired Start Date: ___________________________________
Emergency Contact
Full Name: __________________________________________
Relationship: ________________________________________
Phone Number: _______________________________________
DOT Compliance Acknowledgment
☐ I certify that all information provided is accurate and complete.
☐ I understand I must maintain a valid driver license or CDL permit during training.
☐ I understand that medical certification may be required before CDL testing under Federal Motor Carrier Safety Administration guidelines.
☐ I understand that failure to meet federal or state CDL requirements may affect training eligibility.
Privacy & Communication Consent
All information collected by E Stafford CDL Training will be used strictly for professional business purposes only and will not be shared with outside parties without consent unless required by law.
SMS Communication Consent:
☐ I agree to receive SMS updates regarding scheduling, training, reminders, and school communication.
☐ I understand I may opt out at any time by replying STOP.
☐ I do not wish to receive SMS communication.
Student Signature
Signature: __________________________________________
Date: ______________________________________________