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
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 understand that the fee for the classroom and behind the wheel at J.R.’S. Driving school is $550.00
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.
The fee for B.T.W. ONLY is $400.00 to be paid at the first drive time.
Student Signature
Date
Parent Signature
Date
Should be Empty:

J.R.'s Driving School