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
Additional documents for registration

Bring this registration form and the following documentation to first session.

• 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 ($195.00)Three days 6 hours packages tuition ($495.00)Five days 10 hours package tuition ($820.00)Seven days 14 hours packages tuition ($1,050.00)
Classroom

1. Unlicensed – minimum 6 hours Tuition is - $185.00.
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 $40.00 administrative fee 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.

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Student Information

Current Residence Information

Primary Residence Information (if different from above)

Emergency Contact 1

Emergency Contact 2

Student Physician and Medical Information