STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR
PARENT CONSENT FOR A DRIVER APPLICATION OF
I do hereby consent that___________________________________________________________,
date of birth _________________________ be granted a Florida driver license
and assume the obligations imposed by Section 322.09, Florida Statutes,
unless and until I notify the Department to withdraw this consent.
Signature of Parent, Legal Guardian Print Name
STATE OF FLORIDA
COUNTY OF ______________________
Sworn to (or affirmed) and subscribed before me this ____________day
of ____________________, 20_______,
By ___________________________________ who is personally known to me or
produced Identification _____________________________________________________
as proof of identification.
(Identification type and number)
Notary Public or DL Examiner-Signature
Print, Type, or Stamp Commissioned Name of Notary Public
1. One parent or legal guardian must sign this form.
2. All signatures must be notarized or witnessed by an examiner.
3. Present this form, a social security card (if you have been issued
one), and proof of identity satisfactory to the Department of Highway
Safety and Motor Vehicles, if under 18 years of age. This form is not
required if married.
A PARENT, LEGAL GUARDIAN, OR RESPONSIBLE ADULT (OVER 21 YEARS
OF AGE)MUST ACCOMPANY A DRIVER HOLDING A LEARNER'S LICENSE
Drivers under 18 years of age must meet the following criteria before
they are eligible to apply for a Class E License:
• Hold a Learner's License for a minimum of 12 months.
• No traffic convictions 12 months prior to making a Class E application,
• One non-criminal traffic conviction where an election to complete
a basic driver improvement course wherein the points were not assessed
by the clerk of court (adjudication withheld).
• Parent, legal guardian or other responsible adult over 21 years
of age must certify in person or by notary that the applicant has completed
50 hours of behind the wheel experience, of which 10 hours was night-time
HSMV 71022A (0706)