Student Name: *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a Learner Permit?

Yes

No

How much behind the wheel does the student have? *

None

Around 5 hours

10 or more hours

Parent Phone Number *

(###)

###

####

Terms & Conditions * *

- Student needs to have at least 10 hours of driving practice and their learner permit prior to their first driving session with our instructors

- Students are scheduled based on availability

- There are no refunds outside of 5 days

- If you have not completed your driving hours with-in 12 months, you will need to repay the current program fee.

- Students must have their physical permit on their person for driving sessions. The drive will not take place without their physical valid learner permit

-All instructors and vehicles have been approved and certified with the Utah State Department of Public Safety, Driving License Division

-There is no tolerance for the student consumption of alcohol,drugs, and or chemicals that may interfere with their performance from their behind the wheel obstruction. Any indulgence while partiicapting in this program will result in immediate dismissal with no refund

-The use of in car video cameras to ensure students receive a safe, quality drivers ed experience

-CANCELLATIONS / RESCHEDULING: To avoid a $50 cancelation fee, please notify us at least 24 hours in advance if you need to cancel or reschedule your appointment