DATE OF REGISTRATION___________________

 

DATE OF CLASS_______________________TIME OF CLASS_______________________________

 

NAME_____________________________________________________________________________

 

ADDRESS__________________________________________________________________________

 

CITY__________________________________________ZIP__________________________________

 

HOME PHONE________________BUSINESS PHONE__________________CELL________________

 

DATE OF BIRTH_______________________________AGE__________________________________

 

HIGH SCHOOL OR SCHOOL ATTENDING________________________________________________

 

PARENT APPROVAL

 

I HEREBY GIVE CONSENT FOR MY SON/DAUGHTER TO BE ENROLLED IN THE DRIVING ACADEMY DRIVER EDUCATION COURSE.  I AM AWARE THAT THIS COURSE INCLUDES THIRTY (30) HOURS OF CLASSROOM INSTRUCTION AND SIX (6) HOURS OF IN-CAR INSTRUCTION.  CLASSROOM INSTRUCTION AND DRIVING INSTRUCTION ARE SEPARATE.   

 

A DEPOSIT OF $100  IS REQUIRED AT TIME OF REGISTRATION.  THIS IS APPLIED TO THE TOTAL FEE OF $375.00

AND IS NON-REFUNDABLE IF STUDENT DOES NOT SHOW UP FOR CLASS.  THE BALANCE OF THE CLASS FEE IS

DUE BY THE FIRST DAY OF CLASS.  CDE FORMS WILL BE ISSUED WHEN FULL PAYMENT IS RECEIVED.

 

THERE IS A $25 FEE FOR RETURNED CHECKS.

 

A $50, NO SHOW FEE WILL BE ASSESSED FOR THE FOLLOWING:*

      1.  LESS THAN 24 HOUR CANCELLATION NOTICE
      2.   NOT HAVING BOTH COPIES OF PERMIT WHEN DRIVING
      3.   IMPROPER FOOTWEAR

 *NO EXCEPTIONS

 

 

SIGNATURE OF PARENT/GUARDIAN_______________________________________________________

 

PRINTED NAME OF PARENT OR GUARDIAN_________________________________________________