219 John Birch Drive
Readsboro, VT 05350
PLEASE PRINT USING YOUR COMPUTER PRINTER. THEN PRINT LEGIBLY IN INK, AND MAIL TO SVDS @ ABOVE ADDRESS WITH NO DEPOSIT FOR TEEN CLASS, $200 FOR ADULT CLASS. Please also include SIGNED WAIVER.
1. For which program are you enrolling (check one)?
_____April 16-19, 2018 adult class (must be at least 18 years old)
_____June 20 – July 19, 2018 SUMMER SESSION I teen class (class closed, waitlist open)
_____July 23 – August 22, 2018 SUMMER SESSION II teen class (class closed, waitlist open)
2. Vt. DMV Permit #/expiration date _________________________________________________
3. Legal Name (from permit) _________________________________________________________
4. Name you use______________________________________________________________________
5. Date of Birth_____________________________________________________________________
6. Address (from permit)_____________________________________________________________
8. Phone (cell/home)______________________________/__________________________________
TEEN STUDENTS ONLY
1. Preferred SUMMER drive times (number 1-5 in order of preference)
_____11am-1pm class day _____1:30-3:30pm class day _____9-11am nonclass day _____11am-1pm nonclass day _____1:30-3:30pm nonclass day
2. Parent/Guardian names_________________________________________________________________________________________________
3. Parent/Guardian mailing address_______________________________________________________________________________________
4. Parent/Guardian e-mails_______________________________________________________________________________________________
5. 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. 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.
Parent signature (if student under 18)__________________________________________________Date______________________________