Easy Method Driving School

Registration Form: Driver's Education Course

Personal Information
First Name:
Middle Name
Last Name:
Address:
Address 2:
City:
State:
Zip:
Phone Number:	xxx xxx xxxx
Email Address:
Re-enter Email Address:
Learner's Permit Number:	If you do not have a Learner's Permit yet, leave this field blank and initial the Learner's Permit disclaimer at the bottom of this order form.
Place of Birth:
Date of Birth:	mm/dd/yyyy

Course Information
Classroom Date, Time, and Location
Parent / Mentor	will attend orientation session (first class) will NOT attend orientation session (first class)

Course Options

Student is registering for:

PLAN 1 - $349.00 Special price for February 6th classes in Ellicott City, Clarksville, Columbia, Only!( Savings of $50.00 off regular price of $399.00)

PLAN 2 - $369.00 Special price for classes starting in February 2012. High School locations not included see plan#5

PLAN 3 - $399.00 Special Price for Classes starting in March 2012 High School locations not included see plan# 5

PLAN 4 - $399.00 Special price for classes starting in April 2012. High School Locations not included, See Plan #5

PLAN 5 - $399.00 Special price for classes at Broadneck High School, South River High School, Mt. DeSales High School, North County High School, Old Mill High School (Must be a student at these schools to attend)

PLAN 6 - $133.00 x 3 133.00 CHARGED WITH REGISTRATION, THEN $133.00 AUTOMATICALLY CHARGED TO YOUR CREDIT CARD THE 1ST OF THE FOLLOWING 2 MONTHS. (High School locations not included)

Payment Information
Cost Total:	$
Charge Type:	VISA MASTERCARD DISCOVER AMERICAN EXPRESS
Card Number:
Expiration Date:	(MM/YYYY)
Cardholder Name
CVV2	For AMERICAN EXPRESS enter the 4 numbers on the front top right corner. For all other cards, please enter the last 3 numbers on the back side of your card.

Policies

By initialing below, I agree to the following EASY METHOD DRIVING SCHOOL policies:

*Student is required to attend, participate and pass all required classes and in car sessions.
The student must attend the 1st class in the session. Easy Method Driving School does not recommend missing classes. If the student misses the 1st class in the session the student will not be able to continue in that session. If a student misses more than 4 classes in the original session they signed up for they will have to start the 30 hours of classroom instruction over.

*Students that miss a class cannot take the final exam until that class is made up. Easy Method Driving School will give make up dates when the classroom records are received in the office at the end of the 10 day session the student was originally attending.

*When a student cancels an appointment with less than 48 hours notice, all future appointments will be canceled until a cancellation fee of $30.00 is paid.

*All fees are to be paid at time of service. Student is responsible for all fees prior to completion of course.
Student will not be considered registered for a course until payment is received.
*The Driver Education Course takes a minimum 2 weeks to complete.
*If course is not completed within 12 months, the student will be assessed an additional fee of $30.00 per month for each past due month.
Refunds- a full refund will be issued if the office is notified in writing 3 buisness days prior to the class starting. Refunds will be issued 30 business days from the date of request. Refunds will be issued at a prorated price. $15.00 per classroom session and $60.00 per behind the wheel session will be deducted from the refund.

*A $10.00 fee will be charged for redeposit checks; $25.00 fee for returned checks

*Though Easy Method Driving School tries not to change class or driving times, there are times when it is necessary to
do so. Therefore, EMDS reserves the right to change the scheduled dates of classes without notice. (includes in car sessions.)
*Refunds: Easy Method Driving School will issue a full refund if request is submitted, in writing, 72 hours prior to the start of the program. If a refund is applicable, refunds will be issued 30 business days from the date of the request. Refunds will be issued at a prorated amount. $15.00 per classroom attended and $60.00 per behind the wheel lesson will be deducted from the refund.

I agree: Student's Initials, Parent / Guardian Initials (for under 18 student)

Learners Permit Students ONLY
For Students who do not have a learner's permit: To the best of my knowledge, I know of no physical, mental or legal reason why I would be unable to obtain a Maryland Learner's Permit.

Student's Initials, Parent / Guardian Initials (for under 18 student)