Crowley V Drive Teen Registration

DRIVER EDUCATION REGISTRATION AND COURSE FORM
Tuition and fees are non-refundable. Only one rescheduling of class dates will be allowed. Each additional reschedule will incur a $100 fee. Once class begins, tuition is considered earned in full. No refund or course credit will be given for any course dropped due to attendance, behavior, or other issues. Deposits are non-refundable.
By registering below, I understand and agree to the above Policies and Procedures
Please Choose Class Dates for Crowley V Drive
STUDENT INFORMATION
Name of Student (PRINT First/Last)

First NameLast Name
Date Of Birth

MonthDayYear
Date
Age (must be 17 or under)
Address

Street Address

CityState / Province

Postal / Zip Code
TIP Number (please leave blank if you have not gotten one yet)
TIP Issue Date (please leave blank if you have not gotten one yet)

MonthDayYear
Date
Legal Parent/Guardian Email Address
example@example.com
Student Email Address
example@example.com
CONTACT PHONE NUMBERS
Primary Contact
Format: (000) 000-0000.
Secondary Contact
Format: (000) 000-0000.
Alternative Contact
Format: (000) 000-0000.

Crowley Teen Course Full Balance

($480 plus 4% card charge)

$499.00 Quantity

Crowley Teen Course Deposit

($100 plus 4% card charge)

$104.00 Quantity

Total

DRIVER EDUCATION REGISTRATION AND COURSE FORM