2025 Lesson Request

Lesson Request
Name of Person Taking Lesson

First NameLast Name
Date of Birth

MonthDayYear
Date
Permit Number
Sent Text PMT

MonthDayYear
Date
Left Message Pmt

MonthDayYear
Date
Last Name

Email

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Street Address 2
City
State
Zip
Package Selected
Primary Phone Number
Format: (000) 000-0000.
Phone Number

Other
By checking this box, you consent to receive text messages from Bell's Auto Driving regarding your inquiries and services on this PRIMARY number. You may opt-out at any time by replying STOP. For assistance text HELP. Message and data rates may apply. Messaging frequency may vary. Visit https://bellsdriving.com/privacy-policy/ to see our privacy policy and https://bellsdriving.com/privacy-policy/ for our Terms of Service.
Alternate Phone Number
Format: (000) 000-0000.
Alternate Phone

Other
By checking this box, you consent to receive text messages from Bell's Auto Driving regarding your inquiries and services on this ALTERNATE number. You may opt-out at any time by replying STOP. For assistance text HELP. Message and data rates may apply. Messaging frequency may vary. Visit https://bellsdriving.com/privacy-policy/ to see our privacy policy and https://bellsdriving.com/privacy-policy/ for our Terms of Service.
The purpose of collecting your phone numbers for texting purposes is for Bell's Auto Driving to contact you regarding the services that you have requested. Reply STOP to any text to opt-out; Reply HELP to any text for support; Message and data rates apply; Messaging frequency may vary. Visit https://bellsdriving.com/privacy-policy/ for privacy policy.

Are you looking for more than one lesson?
I am available
Is there anything that you would like for us to know before we contact you to schedule lessons?

Cancellation Policy

24 Hours Notice is required for all cancellations. If 24 hours Notice is not provided the student will be charged a $25 cancellation fee. This fee must be paid before rescheduling the lesson. There is no exception to this policy. If you have any questions regarding this policy, you should contact us as soon as possible to allow us to address your concerns.
The safety of our students and instructors at Bell’s Auto Driving School, Inc. has always been our highest priority. Our current COVID policy is as follows:

All students and instructors will be required to wear masks at all times while in the car. Instructors will continue to clean and sanitize our vehicles in between each lesson in accordance with CDC guidelines.

Our 24-hour cancellation policy will remain in force. If 24 hour notice for any cancellations is not provided you will be subject to the $25 cancellation fee.

If you have any questions regarding the policy/procedures listed in this acknowledgement, you should contact us as soon as possible to allow us to address your concerns.
I understand the above cancellation policy

Signature
Name of Person Signing

First NameLast Name
I agree that I am over the age of 18 and/or the legal guardian of the above mentioned student.
Date

MonthDayYear
Date
You will be contacted by our office about your request as soon as possible.

We truly appreciate your patience - we will contact you back!
Should be Empty:

Lesson Request

Cancellation Policy