Teen Driver Education Enrollment Form

Student Name*

First NameMiddle NameLast Name

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Phone Number*

Please enter a valid phone number.

Student Email*

example@example.com

PARENT Name*

First NameLast Name

Parent Phone Number*

Please enter a valid phone number.

Parent Email*

example@example.com

Eligibility: I understand that, according to the state law: Section 1060.180, the student must satisfy the following and then can attend the teen course.

At least 15 years of age prior to the end of the classroom portion of the course.

needed state forms: if choose first option in the following eligibility options:use Driver Education Approval Form

if choose second option: home schooled , use Home Schooled form

Please choose one eligibility option*

If the student is enrolled in school, he/she has received a passing grade in at least 8 courses during the 2 semesters. Please upload your transcripts or this Driver Education Approval Form: find the form at the link in above Eligibility paragraphIf a student is home schooled, he/she will obtain and upload written verification on a form prepared or approved by the Secretary of State stating the student is enrolled in a home school: find the form at the link in above Eligibility paragraphIf a student who has dropped out of school and has not yet attained the age of 18 years, must satisfy one of the follows: A) obtain written documentation verifying the dropout's enrollment in GED or an alternative education program or obtain a copy of the dropout's GED certificate; B) obtain written verification at the student prior to dropping out, had received a passing grade in at least 8 courses during the 2 previous semesters last ending prior to requesting a certificate of completion; or C) obtain written consent on a form prepared or approved by the Secretary of State from the dropout's parents or guardian and the regional superintendent.

Please upload your file for your chosen eligibility*

· According to Illinois State Law, a Minimum of 30 hours of classroom instruction is required.

· Driving Lessons— Students are required by Illinois State Law to complete a minimum of (6) Hours of Behind the Wheel Instruction, and (6) Hours of Observation (on back seat to watch other driver driving), or just 8 hours Behind the Wheel.

I choose:*

$500: 30 hours of classroom and 6 hours of Behind the Wheel and 6 hours of Observation$620: 30 hours of classroom and 8 hours of Behind the Wheel$360: 6 hours of Behind the Wheel and 6 hours of Observation (please upload your transcripts or proof showing you completed classroom part and upload permit)$480: 8 hours of Behind the Wheel (please upload your transcripts or proof showing you completed classroom part and upload permit)$300: 30 hours of classroom only$60/hour: practice Behind the Wheel only (not certification purpose) (at least 2 hours) (please upload permit)

If you choose the options of $360, $480, and $60, please upload instructional permit and upload your transcripts or proof showing you completed classroom part.

Terms:

· If fail to show up at a scheduled driving session, a $60 fee will be charged before next scheduled driving session.

· According to Illinois State Law, any student absent for more than (4) class sessions will be dropped, and their permit will be rescinded. Students who are dropped will be required to reenroll and start the class over. Should re-enrollment be required, the school will not refund any tuition or part of tuition if the school is capable and willing to perform its part of the contract, and new charges will apply. Any absences of (4) or less must be made up during one of our upcoming classes, and any missed work must be completed. All canceled classes due to weather or unforeseen circumstances will be made up at a later date.

· Driving Lessons—Each Driving Session last for a total of (2) Hours. Students are required by Illinois State Law to complete a minimum of (6) Hours of Behind the Wheel Instruction, and (6) Hours of Observation( or 8 hours Behind the Wheel). (These Hours do not count toward the additional (50) Hours of Practice Driving required by Illinois State Law) Students are required to give (24) hours notice of cancellation. Students who fail to give proper notice of cancellation, will be subject to a $60 fee. Students will not be allowed to drive until this fee has been paid.

· If pickup and dropoff services are requested, we will charge the time on the road for the services ($60/hour, or $30/30 minutes) or you can drop off and pick up the student.

· Under the Influence – Students will be dropped from class if found to be under the influence of Alcohol, or any illegal substances during class or drive time. This is your only warning!! The school will not refund any tuition or part of tuition if the school is capable and willing to perform its part of the contract.

· I agree to pay all expenses resulting from any traffic violations I am responsible for, as well as any raise in my insurance rates as a result of these violations.

· The instructor will effectively and safely teaches the students. The training car has the state required insurance coverage. If because of the student’s fault, an accident happened, the insurance will have limited coverage and for the exceeded the coverage’s expenses, the school will be not able to cover the exceeded expenses and the student will be responsible for it. If the school’s car got damage because of the student’s faults, the student will pay $300.

· The agreement constitutes the entire contract between the school and the student, and no verbal assurances or promises not contained in the agreement shall bind the school or the student.

· All disputes under this Section shall be directed to the Secretary of State's Office; and

· all students attending a full teenage accredited program to complete the entire course within 9 months from the date of the first classroom lesson.

Waiver:

Only the instructor and the student are present in the training vehicle (if other students are not available to accompany). If requested, a parent may be present in the training vehicle, seated in the back seat.

I, the parent/guardian of the student (student is under the age of 18), consents to allow for the behind-the-wheel instruction with only the instructor being present in the vehicle.

Payment:

A deposit of $100 is required at the time of enrollment. The remaining of balance is due the first class. Pay deposit to Zelle: 217 904 5127 I Can Pass Driving School. Or a check front and back images to be uploaded or emailed to icanpassdrivingschool@gmail.com.

Student: I have read and agree all the above terms, the eligibility requirements, and the waiver.*

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Parent: I have read and agree all the above terms, the eligibility requirements, and the waiver.*

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Teen Driver Education Enrollment Form

I Can Pass Driving School LLC