Adult Driving Registration Form

Date

MonthDayYear
Date
Adult Driving Training Course:

Whether you're an adult learning to drive for the first time or an experienced driver trying to improve your driving skills, our course is perfect for you. Our adult drivers education course teaches you the knowledge you need to pass the written license-renewal test and maintain or earn a drivers license. We pinpoint what you need to study to be a better adult driver and pass your written test.

Missed Behind – the – Wheel appointment, the student will be charged $25.00 unless the School is given at least 24 hours’ notice. We appreciate your business. To schedule an appointment, please call or email us. Please include your age, city, and your tuition package.

Each lesson will be 2 hours in either package. Tuition is due in full on the first day of the lesson. Your instructor will collect the tuition. Your payment must be by money order, cashier check, or cash. Personal checks and American Express are not excepted. Adults 18 or older must have a NC Learners Permit.

ADULT DRIVING PACKAGES:

We offer four (4) driving packages below for 18 and older for Behind-The-Wheel only. Each package with your registration forms required a $50.00 deposit (non-refundable, unless we are given at least twenty-four (24) hours notice prior to the start of your scheduled class. A $50 administrative fee will be retained regardless of cancellation date.) Your scheduled appointment is based solely upon the date when we receives your deposit and forms. The remaining balance is due in full on the first day of class.

Individual (one on one) training for adults who wish to earn a license or additional training.

Submit your deposit and registration forms on-line or bring it in-person before your scheduled appointment.
Additional documents for registration

• Original Certified Birth Certificate
• Original Social Security Card
• Current Proofs of Residence (ex. power, water or gas bill)
Preferred Session

WinterSummer
Package Type

One day 2 hours packages tuition: Cash - ($195.00) Credit Cards - ($200.85)Three days 6 hours packages tuition: Cash - ($495.00) Credit Cards - ($509.85)Five days 10 hours package tuition: Cash - ($820.00) Credit Cards - ($844.60)Seven days 14 hours packages tuition: Cash - ($1,050.00) Credit Cards - ($1081.50)
Classroom

1. Unlicensed – minimum 6 hours Tuition is - $195.00.
2. Behind- the – Wheel minimum 6 hours.
3. Students with a Valid Learner Permits may contract for all, or a portion of the classroom and behind – the – wheel instruction.

There is a $50.00 administrative fee (non-refundable) for all approved refunds. There will be a $30.00 fee for all returned checks.

Missed Behind – the – Wheel appointment, the student will be charged $25.00 unless the School is given at least 24 hours’ notice. We appreciate your business. To schedule an appointment, please call or email us. Please include your age, city, and your tuition package.
Schedule Preference
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Ethnicity
Email Address
Phone Number
Please enter a valid phone number.
Grade
Semester
Have you previously applied to or attended this school?

YesNo
If yes, what year?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Student Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Please verify that you are human*
My Products
prevnext( X )
One day 2 hours packages tuition ($195.00)One day 2 hours package
$195.00



Three days 6 hours packages tuition ($495.00)Three days 6 hours package
$495.00



Five days 10 hours package tuition ($820.00)Five days 10 hours package
$820.00



Seven days 14 hours packages tuition ($1,050.00)Seven days 14 hours package
$1,050.00



Behind The Wheel Deposit $50.00Driving Tuition deposit
$50.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Student Information

Current Residence Information

Primary Residence Information (if different from above)

Emergency Contact 1

Emergency Contact 2

Student Physician and Medical Information