219 John Birch Drive
Readsboro, VT 05350

APPLICATION 2017-18
PLEASE PRINT USING YOUR COMPUTER PRINTER. THEN PRINT LEGIBLY IN INK AND MAIL TO SVDS @ ABOVE ADDRESS WITH $150 DEPOSIT

1. For which program are you enrolling (check one)?
_____November 13-16, 2017 adult class (must be at least 18 years old)
_____January 13 – February 26, 2018 WINTER teen class
_____June 20 – July 19, 2018 SUMMER SESSION I teen class
_____July 23 – August 22, 2018 SUMMER SESSION II teen class
_____Individual lessons

2. Vt. DMV Permit #/expiration date _________________________________________________

3. Legal Name (from permit) _________________________________________________________

4. Name you use______________________________________________________________________

5. Date of Birth_____________________________________________________________________

6. Address (from permit)_____________________________________________________________

7. E-mail____________________________________________________________________________

8. Phone (cell/home)______________________________/__________________________________

TEEN STUDENTS ONLY

1. Preferred SUMMER drive times (number in order of preference)
_____11am-1pm class days _____1:30-3:30pm class days _____9-11am nonclass days _____11am-1pm nonclass days _____1:30-3:30pm nonclass days

2. Preferred WINTER drive times (number in order of preference)
_____Saturday pm just before class _____Sunday am just after class ____February 19-23 vacation (specify best time on line below) _____Saturday am _____Sunday pm _____Other (please specify on line below)
____________________________________________________________________________________________________________________________

3. Parent/Guardian names_________________________________________________________________________________________________

4. Parent/Guardian mailing address_______________________________________________________________________________________
____________________________________________________________________________________________________________________________

5. Parent/Guardian e-mails_______________________________________________________________________________________________

6. Parent/Guardian phone (home/work/cell w/area codes)___________________________________________________________________
____________________________________________________________________________________________________________________________

For students taking individual lessons (age 18 and over) payment is by the lesson or prepaid (ten-hour package). Refunds for packages are figured by subtracting hours completed x $70 from $575. If the result is less than $0 no refund is due. The ten-hour package reduces hourly lesson costs by 18 percent but does not necessarily make a student road-test ready; additional hours are billed at $57.50 each.

For teens, on-time attendance is mandatory; winter students ONLY are allowed one legitimate absence without jeopardizing certification for a junior operator’s license, though this is not permission to skip a class! All fees are refundable if the class hasn’t begun AND another student fills a vacated spot from the wait list; with three teen classes in 2018 there may be no waitlist. Full refunds are given in the event a teen class has fewer than 10 enrolled three weeks before the start date. Preferred drive times are not guaranteed.

Your signature below indicates you have read and understand the above.

Student AND Parent signature__________________________________________/______________________________________________ Date__________