Classroom Training ONLY

Classroom Training ONLY - 30-Hour
Payment Options *

Credit Card Check payment (Payment required for every order, must receive within 48 hours for order to be complete. We are unable to hold a seat if not received within 48 hours. )
Dates

September 19 - 22

Dates:

September 19-22 -- Full Payment $ 250.00

September 19-22 -- 50% Deposit $ 125.00

Total $ 0.00

General Information
Parent/Guardian (if applicable)

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Student Information
Driver's Name *

First Name Last Name
Birth Date *

Month Day Year
School Name
Grade
Gender *

Male Female
Student Permit/License # *
If they don't have permit yet type N/A
Expiration Date

Month Day Year
Date
Student's Phone

Area Code Phone Number
Does the driver have any special accommodations we should be aware of (504 Plan, IEP, etc.)? If yes, please describe. *
Special Accommodations Information
Refund Policy

Towne Lake Driving School does not offer refunds. All contracts are good for one (1) year.
Confirmation

BY CLICKING THE SUBMIT BUTTON, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I ALSO CONFIRM THAT I AGREE WITH TOWNE LAKE DRIVING SCHOOL'S PRIVACY POLICY.
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Classroom Training ONLY - 30-Hour