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- $299.99  Weekend Special !! Register for any class in November and SAVE $100.00 off regular price. (High School Locations not included)

PLAN 2- $319.99  NOVEMBER CLASSES! REGISTER EARLY AND SAVE. (THIS PLAN DOES NOT INCLUDE HIGH SCHOOL LOCATIONS). GO TO PLAN #4 FOR HIGH SCHOOL LOCATIONS

PLAN 3- $329.99  SPECIAL PRICE FOR DECEMBER and JANUARY CLASSES!! REGISTER EARLY AND SAVE -(THIS PLAN DOES NOT INCLUDE HIGH SCHOOL LOCATIONS ! ) GO TO PLAN #4

PLAN 4- $389.99  SPECIAL PRICE FOR BROADNECK, NORTHEAST, NORTH COUNTY, OLD MILL, AND MT. DE SALES HIGH SCHOOL payment plans do not apply to these locations

PLAN 5- $135  (THIS PLAN DOES NOT INCLUDE HIGH SCHOOL LOCATIONS )Plus two additional payments of $135.00 with your credit card. The total is $405.00. A Payment is deducted the first day of each month. If your credit card is denied for any reason during this payment plan,, you will be responsible for paying the balance in full before continuing Driver Education. Balance must be paid in full before certificate of completion is issued. This package does not include highschool locations.

PLAN 6- $59.99  SEVEN WEEKLY PAYMENTS PACKAGE- (HIGH SCHOOL LOCATIONS NOT INCLUDED IN THIS PACKAGE)-THE TOTAL IS $419.93 THIS INCLUDES 3O HOURS CLASSROOM AND 6 HOURS BEHIND THE WHEEL. BEHIND THE WHEEL CANNOT START UNTIL THE 8TH WEEK OR ALL PAYMENTS HAVE BEEN MADE.


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.

*When a student cancels an appointment with less than 24 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.
*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 less than 72 hours, but before the first day of class, a fee of $99.95 will be deducted from the refund. No refund will be issued after class begins. If a refund is applicable, refunds will be issued 30 days from the date of the request.

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)