Registration Form

J.R.'s Driving School
701 Devonshire Dr. C-16

Champaign IL 61820

217-398-6189
REGISTRATION SECTION
Name (Last) *
(First) *
(M.I.)
Address *
City *
State *
Zip Code *
Telephone *
Birthdate *

Month Day Year
Date
School *
Parent Name
Parent Email
example@example.com
Work Phone
Email (Needed for Zoom class) *
example@example.com
Program

Teen Classroom & BTW ($500.00) JAN 2021 BTW Only ($400.00 or $70.00/hour) Adult BTW ($70.00/hour)
PARENTAL CONSENT SECTION
June 1, 2020
Dear Parent/Guardian,

As you know J.R.'s Driving school has re-opened as of June 1, 2020. Per the Secretary of State we have guidelines that were put in place to keep our staff and you child/children safe. We ask that all students and driving instructors wear a mask during the driving portion of Behind the Wheel sessions. Each car will be cleaned and wiped down in between each student. There will also be hand sanitizer in each car.

Per the guidelines set before us, there will be only one student in the car for an hour lesson. If your child is not feeling well it is best to cancel the drive for that day.

We would like for you to sign this statement indicating you agree with having your student in the car for a one on one driving lesson with the instructor.
Parental Consent

I consent to one on one BTW lessons, with instructor and student each wearing masks.
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 $500.00

Yes
A non-refundable $100.00 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 $400.00.00 to be paid at the first drive time.

Agree
Student Signature

Clear
Date
Parent Signature

Clear
Date
Should be Empty:

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J.R.'s Driving School

REGISTRATION SECTION

PARENTAL CONSENT SECTION

TEENAGE STUDENT ELIGIBILITY SECTION