Coastal Area Driving Academy Registration Form

Coastal Area Driving Academy Registration Form

Welcome! Please fill out the registration form and choose your classroom choice. Thank you for choosing Coastal Area Driving Academy!
Hybrid Class Choice or AAA Blended Flex Online Course- (both options offered in) Belfast, Thorndike or Bucksport - Please list TOWN LOCATION and HYBRID or AAA option
Student Legal Name

First Name Middle NameLast NameSuffix
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Email (email will be sent to the student)
example@example.com
Student's Date of Birth (proof of DOB required by BMV mandatory prior to first day of class via birth certificate or current passport)

MonthDayYear
Date
Please Upload Proof of Student Date of Birth.

Cancelof
By State of Maine Law, students must be 15 years of age on the first day of class. Proof of age is required to enroll in Driver’s Education and is needed attached with this registration form. If the student registered is at least age 15 on the first day of class, the deposit is non-refundable. Student will be placed in the next available, open class that is not full class, as their age permits. The deposit will be held a maximum of 6 months from the date of the original application. After 6 months the deposit is forfeited and will not be credited toward another class. Any copy of birth certificate, passport or other legal document showing proof of their date of birth is acceptable.
Student's Age on the First Day of Class:
Student Gender
Does the student have any of the following medical conditions? (Check all that apply)
If you selected any medical conditions from above, please explain below or this box can be used to make a note to us here:
*Parent/Guardian Information Required if Student is Less Than 18 Years of Age* Please select if you are the Parent, Guardian, or Payee
Parent/Guardian or Payee Name-

PrefixFirst NameLast Name
Parent / Guardian or Payee Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent /Guardian or Payee Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian or Payee Email (email will be sent to Parent/Guardian/Payee)
example@example.com
Belfast live class from 5:00 pm -8:00 pm and Thorndike live class from 3:15 -6:15 pm - HYBRID classes with zoom classes (5:00-8:00 pm)- Choose your class date. Tuition is $625.00.
Bucksport live classes from 3:00 pm - 6:00 pm - HYBRID classes with zoom classes (5:00-8:00 pm) Choose your class date. Tuition is $625.00.
AAA Blended Flex Online Course- Self-Paced class options located at Belfast, Thorndike, and Bucksport locations- Choose your class option and date. Tuition is $625.00, with an additional $49.95 non-member or $39.95 member cost paid to AAA to purchase the program.
We will be teaching the curriculum from AAA “How to Drive, 15th Edition" via Powerpoint. If you choose to purchase the textbook outright or E-book to have in addition to what's taught in class, it can be done at the following link: https://drivertraining.aaa.biz/products/how-to-drive-student-textbook. This is optional.

Payment Options: $100.00 Deposit needed to hold your seat in any class. Pay in Full option also available. Tuition cost is $625.00 for all class options. The AAA Blended Flex Online tuition is $625.00 plus an additional $39.95 (for members) or $49.99 (for non-members) to AAA to access course materials paid to them directly. Any balances remaining will be due on the first day of class. .

USDDescription

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Student's Signature:
Parent/Guardian Signature:
Should be Empty: