Student Information:                                                        Date:____________

Last Name:____________________________ First Name:_______________

Address:______________________________ Phone: __________________

City:___________________________State/Zip:________________________

Permit/Licensed Number:__________________________________________

Parents Request for Driver's Education

I hereby request that my (daughter/son),_______________________________
be enrolled in your state-approved driver education with the understanding that he/she will be under All State Driving School supervision during whether the classroom portion and/or the Behind the Wheel phase of the program.

This agreement will be in effect for only one year from the date on this application. Should your daughter/son not complete this instruction in this time period all monies are forfeit and no refunds will be given. Every effort will be taken to insure all instruction will be offered during this time limit. The fact the person does not obtain a learners permit during this time is not the responsibility of the driving school and will not be cause for extension of this contract.

I further understand and agree to the conditions of the information on the bottom of this page.

I assure my full cooperation. My daughter/son has a learners permit from Virginia.

                                                                _____________________________
                                                                Parent or Guardian Signature

Type of training desired: 
___Classroom Only     ___ Behind The Wheel only   ___Both types of instruction

All Star Driving School agrees to:

1. Furnished certified driving instructor with property marked automobiles to students for the period session.
2. Provide a classroom if necessary that meets the Commonwealth of Virginia guide lines for instruction.
3. Abide by and enforce the laws of the Virginia Division of Motor Vehicles (DMV) during instruction.
4. Keep the proper records as required by the DMV and submit same as required by the DMV.
5. This Driving School will faithfully serve the students and pledges itself to the public to conform to the highest standards of driving instruction and the use of the best motor vehicles it can provide.
6. A refund will be provided of the fees upon request, the Driving School is not capable of performing the school's part within one year from the date of the reverse side of this form, i.e. no driver provided a student to learn to drive and/or a classroom to teach in. If a student does not obtain a Learners Permit during this time period and cannot drive because a Learners Permit is required by DMV before a student may drive an automobile, it is not the fault of this driving school and the contract is not extended. All monies paid will be forfeit.
7. There is a $35 fee for returned checks as well as a $35 fee for scheduled appointments canceled without a 24-hour notice. This is a policy enforced by the All Star Driving School and will be issued without exception.

The Student agrees to:

1. Pay for all instruction at the beginning of the course of instruction.
2. Forfeit all money for uncompleted instruction if offered but not taken advantage of within one year from the date on the reverse side of this contract.
3. Be under the Driving School's supervision during any scheduled and non-scheduled instruction.
4. Dismissal for failure to follow the Driving School Guidelines, rules, instruction and Virginia DMV laws, with no refunds. Mature behavior is expected.
5. Pay a fee of ten dollars for each period/session scheduled and missed through no fault of the Driving School instructor in the Behind-The-Wheel only.
6. Understand that the instruction provided does not guarantee that any student will pass the state license examination or that the student will be guaranteed employment upon completion of any course of instruction.
7. Arrange prompt pick-up from classroom portion of the program.
8. Pay a fee in accordance with the fees established by the following driving fee chart or by special agreement.
9. The fee in accordance with the fees establish by the following driving fee chart or by special agreement.  Classroom_________Behind-the-wheel________Driver Improvement Clinic_____

Note: Successful completion of a State-Approved Driver Education course does not imply that the student is an accomplished driver. No one can be considered a skilled driver until he/she has driven for three to five years behind the wheel.

  INSTRUCTOR#________                              (703)680-0045                RECEPTIONIST________

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ALL STAR DRIVING SCHOOL
P.O. BOX 1454 ANNANDALE VA
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