Adult Forms

For Office Use ONLY:    date received:_______________
copied:______    paid:____________    cash / check#____________    receipt#____________


_______________________________________________________________________

First                                                Middle                                                Last

Birth Date:____/____/____
Mo.   Day   Yr.

_______________________________________________________________________
Address                                             City                                                  Zip

Home Phone:(____)__________________  Cell Phone:(____)__________________

E-mail address:______________________@_____________

What school do you attend?_______________________________________________

How did you hear about this course?__________________ From whom?____________

Type of Instruction Desired:
Please check the package that you would like to purchase.
The rate for the Behind the Wheel driving is $57(55 cash) per hour.

No.

Package

Price

X

#1

*9 hours of “Behind the Wheel” driving only.

$510/$495c

#2

*6 hours of “Behind the Wheel” driving only.

$340/$330c

#3

*3 hours of “Behind the Wheel” driving only.

 $170/$165c

#4

24 hours of classroom instruction.
(In a teenage classroom setting.)

$102/$100c

(If applicable)
What course are you interested in? Date:__________________ Time:_____________

Check the class location:  ____ Burton  ____ Swartz Creek

*Every 10 minutes of trip time will be $5. A TRIP CHARGE may be added to drive depending on the pickup and drop off location.
All or half of the cost should be paid on the first drive. Any additional practice driving will be $55 per hour. Most clients average 6 to 9 hours of instruction.

Course Work-Package #4 only
24 hours of classroom instruction. Major Driving School will provide the textbook and all materials needed for the course work.

Method of Payment
Complete payment can be made by cash or check. Before any instruction, classroom or “Behind the Wheel” will be given, payment in full or half must be received. Any returned checks will be assessed a $20 charge.

Refund Policy-Packages #1, #2, and #3 only
If a student cancels before the first day of class, 100% of the cost paid will be refunded. After the 1st or 2nd day of class, 75% will be returned. After the 3rd, 4th, or 5th class day, 50% will be refunded and after the 6th class day, you will be responsible for the entire fee. No refund will be given for individual “Behind the Wheel” lessons or individual classroom refresher course lessons.

The student certifies that he/she is at least 18 years of age by the first day of class and has no physical handicaps that will interfere with driving an automobile.

_________________________  ______________________
Student Signature                   Date

_________________________  ______________________
Major Driving School Official     Date

Notice Statement: “This school is required to be licensed by the Michigan Department of State, Driver Training & Testing Programs. If you have a complaint which you cannot settle with this school, write: Michigan Department of State, Driver Training & Testing Programs, Lansing, MI 48918. Completion of driver trai

Road Tests, Teen and Adult Driver Education, Ticket Resolution