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Next Class Starting August 15th

 

FULL NAME OF STUDENT  First_________________Middle________________Last_______________ Address______________________________________________________ City_______________________________Zip Code__________________

School Attending_________________________________Home School____ High School____________________Middle School___________________

Phone____________________________ Cell Phone____________________________

Date of Birth___________________________

Social Security Number______________________________________________

Email Address____________________________________________

Student Signature__________________________________________Date__________________________

 

PARENT OR GUARDIAN INFORMATION

Name_____________________________________________ Address___________________________________________ City_________________________________Zip Code_____________________

Work Phone___________________________ Home Phone__________________________ Cell Phone____________________________

Parent or Guardian Signature_____________________________________Date______________________

 

EMERGENCY CONTACT Doctor________________________________Phone__________________ Hospital_______________________________Phone__________________

 

Does the student have any disabilities? If so, please explain_______________________________________________________________

Does the student have any special needs or modifications that are part of his or her educational program?________________________________________________________________________________________

 

 

Please mail the registration fee, this form, and a photocopy of your driving permit to:

Drive Pro, Inc.

Mikel W. Ghere 

4791 Roseman Drive

Clear Lake, Iowa 50428

Please call 641-420-5822 if you have any questions.

 

Cost is $330. Payment can be made in cash, credit card, or check payable to Drive Pro, Inc. The cost can be made in two installments. 1st payment is due with registration form; 2nd payment is due two weeks after starting date. There is a $11 service charge for credit card transactions. Certificate will be issued 30 days after personal check if received. Payment for the class tuition will not be dependent on the student passing the class. Missed driving classes will cost $25 if not cancelled the evening before. Each student will be presented a white certification slip at the end of the course. If this slip is lost, it will cost $25 to have a new one issued. There will be no refund after the first class has started.

 

Please call 641-420-5822 if you have any questions. We are looking forward to serving you.