PDS North Agreement Paperwork

PDS North Agreement Paperwork

PROFESSIONALDRIVING SYSTEMS 5335 Far Hills Ave Suite 125, Dayton, OH 45429 937-439-4130
PDS North Behind the Wheel Training is ONLY offered to students between the ages of 15 1/2-18 years old and that live within the following zip codes:

45312 45339 45356 45359

45371 45373 45374 45383

If you fail to meet the requirements, your registration will be denied. The temporary permit must include one of the zip codes listed above.
Prior to completing the registration form, please gather/prepare the following:

o   The student’s test score from the online classroom portion of the training. Must be 75 percent or higher.

o   File or still photo/screen shot of certificate of completion from the online classroom portion of the training. (Must be from a state accredited online program).

o   File or still photo/screen shot of the student’s valid temporary permit

o   File or still photo/screen shot of student’s updated driving log. The student should have a minimum of 15 hours. However, we recommend that the student has 20 hours or more for the best experience during our training. Continue to keep the log of drive time with the parent. The BMVs are now requiring that documentation for the student to obtain a driver's license.

o   Credit card for the non-refundable payment to complete the registration. There is a 3.25% fee that will be assessed by the credit card company.

Upon completion of the Behind the Wheel Registration form, you will receive an email confirming your registration within three business days.

An instructor will contact you within 14 business days following your registration to discuss the Behind the Wheel training schedule.
Students Full Legal Name*

First NameMiddle NameLast NameSuffix
Students Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Parent/Legal Guardian Names*
Parents Email*
example@example.com
Student Birthdate*

MonthDayYear
PDS North is ONLY for students ages 15 1/2 - 18 years old.
High School*
Student Gender*

MaleFemale
What was the student's test score for the classroom portion of the training? *
Please upload a clear photo of the student's driving log. *

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Please upload a clear photo of the student's valid temporary permit.*

Cancelof
Please upload a clear photo of the Classroom Certificate of Completion*

Cancelof
Check the boxes below to indicate which times you should be available for the Behind the Wheel training. (Check all that apply)
Weekday Mornings

Monday 8a-12pTuesday 8a-12pWednesday 8a-12pThursday 8a-12pFriday 8a-12p
Weekday Afternoon

Monday 12-4pTuesday 12-4pWednesday 12-4pThursday 12-4pFriday 12-4p
Weekday Evenings

Monday 4-9pTuesday 4-9pWednesday 4-9pThursday 4-9pFriday 4-9p
Weekends

Saturday AMSaturday PMSunday AMSunday PM
How did you hear about Professional Driving Systems?
Do you have any additional questions / comments?
PDS North Package Options (Non-Refundable) *

$500 Behind the Wheel Only (8 hours)$575 Behind the Wheel Only (8 hours) plus SKID Training (The SKID Portion will only be offered at PDS Driving Range at 3600 Vance Rd. Moraine, Ohio 45439. Transportation to and from the SKID training is your responsibility).
Name as it appears on the credit card used for payment. *
Parent Signature*

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Parent/Legal Guardian Names*
Student Signature*

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Student Name*

First NameLast Name
Please select any medical conditions that may affect him/her in the car.*
In the event neither parent can be contacted, I hereby authorize Professional Driving Systems or their designee to provide emergency medical care for my child when, such medical care will be for the best interest of the child and should not be delayed. I understand that Professional Driving Systems has insurance which pays for medical costs that might be incurred as a result of a traffic crash in our car. Consequently, I understand that any other medical emergency is my sole responsibility.
Parent/Legal Guardian Signature*

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Parent/Legal Guardian Names*
Should be Empty:

PDS North Agreement Paperwork

Check the boxes below to indicate which times you should be available for the Behind the Wheel training. (Check all that apply)