Date:__________

Beginning Class Date________

Agreement No._________

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Name(First/M.I./Last): Date of Birth:

Street: City: State: Zip:

Phone: Parent’s Names:

I agree to pay a fee of $210.00 for 6 hours of behind-the-wheel instruction and 6 hours in-car observation. Additional behind-the-wheel instruction, if student requested, at $50.00 per hour. Classroom instruction was completed at .

I agree to pay a fee of $50.00 per hour for each hour of behind-the-wheel refresher training. I am aware that refresher training is only given to persons with previous driving experience and I certify that I have previous driving experience by making application for such training.

I agree to pay a fee of $50.00 per hour for each hour of behind-the-wheel training. Fee is to be paid before each lesson.

The school will not refund any tuition or part of tuition if the school is ready, willing and able to fulfill its part of the agreement.Students can and will be dismissed from class for disruptive behavior, with no refund.

A charge of $25.00 will be made for each lesson missed which was not cancelled.

This agreement constitutes the entire contract between the school and the student, and no verbal statement of promises will be recognized.

Payment included: I have paid Online with PayPal, or  I am sending a Money Order Or Check with this contract.

Signature of Student:

___________________________________

Signature of A-Alert Representative:

___________________________________

Signature of Parent:

___________________________________

Date:

___________________________________

Please print, sign and date two (2) copies.