Traffic Safety Certificate Form Please complete this form along by keithmurray

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									                          Traffic Safety Certificate Form



Please complete this form along with the payment form for the upcoming Traffic
Safety Education Class held at Fife High School.
This form must be completed in order to receive the Traffic Safety Certificate.
Please print with black or blue ink pen.



Full Legal Name ___________________________________________________
                      (Name must match your birth certificate)

Birth date: ____________________________
                (mm/dd/year)

Male      Female (circle one)

Address: __________________________________________________________

City: ____________________________

County:   King or Pierce      (circle one)

Course:    1st Semester     2nd Semester     Summer (circle one)

TSE start date:_____________ End date:________________

								
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