Springfield Registration Form

J.R.'s Driving School
701 Devonshire Dr

Suite C-16

Champaign IL 61820

217-398-6189 Office

217-530-5005 Cell
REGISTRATION SECTION
Name (Last)*
(First)*
(M.I.)
Address*
City*
State*
Zip Code*
Telephone*
Birthdate*

MonthDayYear
Date
School*
Parent Name
Parent Email
example@example.com
Work Phone
Email (Needed for Zoom class)*
example@example.com
Type a question

Behind the Wheel Only $ 400.00Adult BTW Only $ 70.00 per session
TEENAGE STUDENT ELIGIBILITY SECTION
I understand that I may register to take the driver education course offered by J.R.’S. Driving School but the school will not be able to request a blue slip from the Secretary Of State until I prove that I am eligible in one of the following ways:
Eligibility*

I am enrolled in high school and have passed 8 courses during the previous 2 semesters.I am home schooled and present a signed form from a parent documenting this fact. (The above named person, is home-schooled. I do hereby give my permission for her/him to take driving instructions from a Commercial Driver Training School by my signature below.)I have dropped out of school and have enrolled in an alternative school. ( Written documentation required)
I understand that the fee for the classroom and behind the wheel at J.R.’S. Driving school is $550.00

Yes
A non-refundable $150.00 deposit is required at the time of enrollment. The remaining balance of $400.00 is due the first day of class.

Yes
The fee for B.T.W. ONLY is $400.00 to be paid at the first drive time.

Agree
Student Signature

Clear
Date
Parent Signature

Clear
Date
Should be Empty:

J.R.'s Driving School

REGISTRATION SECTION

TEENAGE STUDENT ELIGIBILITY SECTION