Date of application ____________
Five Star Driver Education Center, Inc.
On-Line Contract & Registration
Student's Full Name _____________________________________ M/F
Address _______________________ City ____________ State _____ Zip ________
Date of Birth _______________ Phone # _____________ Cell # ______________
Parent/Guardian _______________________ Address _________________________
Parent Employer _________________________ Phone # ______________________
Emergency # _____________ Name ________________ Relationship ____________
Doctor's Name ___________________________ Phone # ______________________
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 Five Star Driver Education Center for the described Course of
Instruction.
(Choose those that apply.)
_____Five Star Driver Education Center will provide an on-line classroom
experience, six hours of driving instruction and a test prep class for $350..
_____Five Star Driver Education will provide six hours of driving instruction and
a test prep class for $250. (I have already taken the on-line classroom.)
_____Five Star Driver Education will give the BMV option of the drive test
for $20.
An owner, officer, instructor, agent, or employee of any 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.
I herely 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
______________________________ _________ $350 Course Fee Pd _______
Student Signature Date
Code provided _______________
______________________________ _________
Parent Signature Date $250 Driving Only Fee Pd ______
On-line Contract 11-12
$20 Drive test fee Pd ______
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
