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A+ DRIVING SCHOOL, INC. DRIVER EDUCATION AGREEMENT PRE-REG EMAIL: ____________________________________________ PRE-REGISTER #: __________________ REFERRED BY: _____________________________________________ PREVIOUS SIBLING NAME: ___________________________ CLASS START DATE: _______/________/________ Licensed instruction will be provided to: APP # (office use only) _______/_________/________ First Middle Last HIGH SCHOOL/ NAME: _________________________________________________________ COLLEGE _________________________________ (Attending) ADDRESS: ______________________________________________________ STUDENT D.O.B. ________/________/_________ CITY: ___________________, CO ZIP: _____________ HM PHONE:_________________ MEDICATION __________________ MOTHER’S NAME:___________________ PLACE OF WORK: __________________ WORK PHONE: ________________ FATHER’S NAME: ____________________ PLACE OF WORK: __________________ WORK PHONE: ________________ MOTHER CELL: __________________ FATHER CELL: _______________________ STUDENT CELL: ____________________ DRIVER EDUCATION PROGRAMS 36 HOUR PROGRAM FEE: Includes 30 hours Classroom PLUS THREE (3) driving lessons @ 2 hours each. $545.00 TOTAL of SIX (6) Hours Behind-The-Wheel (State approved & insurance credited) (Class may be taken no earlier than 14 years 6 months) ____________________________________________________________________________________________________________________________________________________________ 4 HOUR PROGRAM FEE: State approved course for students 15 ½ years and older $100.00 Permit test available to all students Permit test requires (1) hour additional classroom training Cost: $30.00 ______________________________________________________________________________________________________________________________________________________________ ADDITIONAL DRIVES: $175.00 (Automatic) Behind-the-Wheel lessons are two (2) hours in length. $200.00 (Stick Shift) One-on-one instruction with a Colorado Certified Instructor. Program Fee: $ ______ DATE PAID_____/_____/_____ AMOUNT PAID $__________ Additional Drives: ____ Fee: $ ______ CK# _________ CASH_____ CC type ______________ ___________________ Credit: $ ______ Card # _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ TOTAL DUE: $ ______ Exp: _____/_____ CVV ______ Approval ___________ ADDITIONAL SERVICES AVAILABLE: Corporate Remedial Classroom / Driving Training (3 hrs) FEE: $ 300 ___________ Permit Test FEE: $ 30 ___________ Driver’s License Testing (own car) (Non-Students) FEE: $ 80 ___________ (A+ Vehicle) FEE: $100 ________ Driver’s License Testing (A+ Students only) FEE: $ 60 ___________ (A+ Vehicle) FEE: $80 ________ In Home Study Plan (Includes permit test and (6) hours driving) FEE: $ 545 ___________ *************************************************************************************************************************************** A minimum 48-HOUR NOTICE is required to cancel a Behind-the-Wheel lesson or a FEE of $30 must be collected before the next lesson. A completion certificate will not be issued if any monies are due. If the above signed Student does not have his/her PERMIT in possession at time of appointment, a $30 “NO-SHOW” FEE will be assessed. This contract is non-transferable and tuition fee is non-refundable. There is a $26 fee on all returned checks. This agreement constitutes the entire contract between the school and the student, and any verbal assurances or promises not contained herein are not binding on either the school or the student. Your typed signatures below indicate agreement with the aforementioned statements. *************************************************************************************************************************************** STUDENT SIGNATURE ______________________________________________________________________ DATE ________________________ PARENT/GUARDIAN SIGNATURE ______________________________________________ DATE ___________________ 10841 S. Crossroads Dr., Suite 1 Parker, Colorado 80134 Office: 303-400-4555 Fax: 303-841-6084 www.a-plus-drivingschool.com [email protected] (Revised 06-11-2020) Cash or Credit Only Email completed contract to [email protected]
