Drive Pro, Inc.

Driver Education School

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Next Class Starting May 2nd

FULL NAME OF STUDENT

First_________________Middle________________Last_______________

Address______________________________________________________

City_______________________________Zip Code__________________

School Attending_________________________________Home School____

High School____________________Middle School___________________

Phone____________________________

Cell Phone____________________________

Date of Birth___________________________

Social Security Number______________________________________________

Email Address____________________________________________

Student Signature__________________________________________Date__________________________

PARENT OR GUARDIAN INFORMATION

Name_____________________________________________

Address___________________________________________

City_________________________________Zip Code_____________________

Work Phone___________________________

Home Phone__________________________

Cell Phone____________________________

Parent or Guardian Signature_____________________________________Date______________________

EMERGENCY CONTACT

Doctor________________________________Phone__________________

Hospital_______________________________Phone__________________

Does the student have any disabilities? If so, please explain_____________

Does the student have any special needs or modifications that are part of his or her educational program?________________________________________________________________________________________

Please mail the registration fee, this form, and a photocopy of your driving permit to:  Drive Pro, Inc. Mikel W. Ghere, 4791 Roseman Drive, Clear Lake, Iowa 50428.  Please call 641-420-5822 or 641-357-8756 if you have any questions.

Cost is $300.  Payment can be made in cash, credit card, or check payable to Drive Pro, Inc.   The cost can be made in two installments.  1st payment is due with registration form; 2nd payment is due two weeks after starting date.  Certificate will be issued 30 days after personal check if received.  

Payment for the class tuition will not be dependent on the student passing the class.  Missed driving classes will cost $25 if not cancelled the evening before.  Each student will be presented a white certification slip at the end of the course.  If this slip is lost, it will cost $25 to have a new one issued.  There will be no refund after the first class has started.

Please call 641-420-5822 or 641-357-8756 if you have any questions. We are looking forward to serving you.