After School Program Enrollment Form

H.A.R.T House is pleased to offer our 'New Driver Maneuverability' for young adults ages 21 years or older. In Ohio, all new drivers are required to pass their maneuverability course prior to hitting the road. Our Network launched a new initiative focused on expanding the mindset of Ohio's young adults with an interactive and instructive program that promotes impactful, positive student learning. Our goal is to support efforts that prepare young adults to participate in the maneuverability Test Prep Course work and successfully pass the driver exam with confidence.

Please complete and submit one form per student being enrolled in the New Driver Maneuverability Course.

How did you hear about us

Student information

First NameLast Name

Indicate Payment type

Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Phone Number

Area CodePhone Number

Student Email

Students Date of Birth

Please ensure the proper format when entering date of birth, for example 01-01-2001.

Current Age Level (must be at least 21 years old to participate in program)

Gender

Has the student taken the Drivers exam in the past?

Does the Driver have past experience behind the wheel?

Please Note:Pick-up and drop-off is optional for an additional fee, call for details.

Select desired date & time (session 1)

HourMinutesAM/PM Option

Select desired date & time (session 2)

HourMinutesAM/PM Option

Select desired date & time (session 3)

HourMinutesAM/PM Option

Please Note: Session 4 will be scheduled for 1 day prior to your scheduled drivers exam.

Does the student have any Medical Condition(s)?

If 'Yes' is answered to the above question please detail medical condition(s) below: N/A if no not applicable

Please list any medications that will be administered during program hours, including dosage, strength and time below: N/A if no not applicable

Please note any known allergies: N/A if no allergies

Notes (specific indication)

***PLEASE NOTE: HART HOUSE IS NOT A DRIVERS EDUCATION SCHOOL. HART HOUSE IS NOT AFFILIATED WITH ANY OHIO BMV OR EXAM STATIONS.

An Enrollment Form is required for all students participating in the New Driver Maneuverability Course.
Students are required to schedule their (3)-One hour sessions prior to the start of the New Driver Maneuverability Course.
Session (4) should be scheduled for the date of students exam day or the day prior to the exam.
Cancellations must be done 24 hours in advance, otherwise the student does NOT reserve the right to reschedule.
No call no show to sessions will result in the loss of that session.
Students may NOT participate on a drop-in basis. If no Enrollment Form has been previously submitted, you will receive an email with the link to this form to complete and submit.
An Enrollment Form is required for all students participating in this program.
All students attending the New Driver Maneuverability Course is required to show proof of their Ohio Temporary Drivers License.

All students attending the New Driver Maneuverability Course are required to follow all program rules and rules stated within the OH BMV instruction.

Students with a fever or contagious illness may not participate in the program until well enough to do so.
This program is available for students ages 18 years or older
No Refunds, however, HART House offers a one time class exchange (where space is available)

I have read and understand the New Driver Maneuverability Course program policy and rules found above. If I fail to adhere to the terms of the program it will result in the removal from said program.

I have read and understand the Enrollment policy, failure to agree will result in denial of enrollment

I give H.A.R.T House permission to use pictures, recordings and video footage of student interacting and engaging in program activities.

Select Today's Date

Please indicate the month day and year the enrollment form is complete. Please ensure the proper format when entering enrollment date.

Upload a copy of your state of Ohio issued Temporary Driver's Permit

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*Please note that the cost includes applicable processing fees.

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New Driver Maneuverability Course. New Driver Maneuverability Course, is (4) one hour courses that guide you through the Ohio BMV laws and regulations . The maneuverability course is taken in 4 sessions, 1-hour per session, onsite with a HART House provided vehicle.

New Driver Maneuverability Course$207.99

New Driver Maneuverability Course, is (4) one hour courses that guide you through the Ohio BMV laws and regulations . The maneuverability course is taken in 4 sessions, 1-hour per session, onsite with a HART House provided vehicle.

Quantity
Item subtotal:

Pick-up $25.00

Pick-up for all sessions + pick-up for drivers examination.

Drop-off$25.00

Drop-off for all sessions + drop-off after drivers examination.

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Total $0.00

Payment Details
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Credit Card Number	Security Code
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Maneuverability Course Registration Form

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