permission slip

Name*

First NameLast Name
Parent Name
Street Address*
City*
State*
Zip Code*
County*
Date of Birth*
Phone*
Phone 2
Driving Experience*
Permit Yes or No
Email*
example@example.com
Ethnicity

HispanicWhiteAsianBlack / African AmericanAmerican Indian / Alaska NativeNative Hawaiian / Pacific Island
Gender

MaleFemale
Health Issues (Driving Related)
- I am aware that students may not be scheduled to drive until full payment has been received by the driving school.
- I am aware that all class time and driving time is required prior to successful completion.
- I am aware that I must give 12 hours notice if a scheduled driving appointment must be canceled. A $50 penalty must be paid from the student to the in car instructor if proper notice is not given.
- There is a 1 year time limit on the completion of the entire driver education program. Failure to complete in 1 year will result in a grade of incomplete and the student will have to restart the program in order to continue.
- Refunds will not be offered after 1 year of program start date.
- I am aware of the risks involved with the COVID 19 virus, as well as the risks associated with learning to drive, and give permission to the driving school to train and educate this student in both classroom and vehicle in accordance with the MD Standardized Curriculum.
- Due to a delay in the driving portion of the program during the COVID 19 State of Emergency, there may be a slight delay in the scheduling and completion of driving appointments. We will do our best to attend to the desires of those individuals that are closest to testing for provisional license first. Please be patient. Our staff is working hard to address our behind the wheel student volume.
Parent or Driving Coach Signature*

Clear
Must be 21 years old or over
Student Signature*

Clear
Please verify that you are human*
Students will be contacted by phone or in class regarding driving appointments. Please inform the classroom instructor of special concerns related to vacation, permit expiration, and in car instructor requests.

Questions regarding these policies and other driver education issues may be directed to the Allegany Driving School office at 301-766-0087.
Date

MonthDayYear
Date
Owner
Jim
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