Month of Class _____________________________ Time _____________
Date of application ______________
Five Star Driver Education Center, Inc
Contract & Registration
Student’s Full Name__________________________________________________________ M/F
Address ______________________________ City ________________ State ____ Zip _______
Date of Birth _________________ Phone # ___________________ Cell # _________________
Parent/Guardian _______________________________ Address ___________________________
Parent Employer ___________________________________ Phone number _________________
Emergency # ____________ Name _________________________ Relationship ____________
Doctor’s Name _______________________________ Phone number __________________
This is a contract between Five Star Driver Education Center, Inc. and the above student and the undersigned parent/guardian. In this contract the parent/guardian and student agree to pay $350.00 to Five Star Driver Education Center for the described Course of Instruction. Furthermore, the parent and student have read and signed the “Code of Responsibilities for Driver Education Students/Driver Education Students Bill of Rights” provided by the state. (See accompanying documents.)
An owner, officer, instructor, agent, or employee of any commercial driver training school shall not state nor give the impression to a student that upon completion of the course, they will guarantee the securing of a driver’s license to operate a motor vehicle. After completion of the course, the student must still meet any and all requirements established by the BMV before the BMV will issue the student a valid driver’s license.
The class fee is $350.00 (A $30.00 non-refundable deposit is required for registration.) The balance of the course fee is due at the start of class.
I hereby give consent for my son/daughter to be enrolled in the driver education course of Five Star Driver Education Center. By my signing this contract I am acknowledging that I have read and understand the registration materials.
For Office Use
__________________________ ____________
Student Signature
Date$30 Registration Fee Pd ________
Date$30 Registration Fee Pd ________ $320 Balance Pd ________
__________________________ ____________
Parent Signature Date
Contract, ‘09--’10
Registration and Contract
Address:
303 N. High St.
Muncie, IN 47305
303 N. High St.
Muncie, IN 47305
Phone Number:
(765) 284-0892
Fax Number:
(765) 381-0085
(765) 284-0892
Fax Number:
(765) 381-0085
Email:
5stardrive@comcast.net
Contact Information
