Enrollment Form PDF Print E-mail

 

ENROLLMENT FORM FOR THE ST. PIUS X

 

CATHOLIC HIGH SCHOOL DRIVER'S EDUCATION COURSE

In conjunction with Nathan's Driving School, Inc.

Interested parents must complete this form (please print legibly or type), sign it, mail, email, or fax it with your credit card information (see below) or your check or money order made payable to Nathan's Driving School, Inc. for the appropriate full tuition  to:

 

Nathan's Driving School, Inc.
5105 Peachtree Industrial Boulevard - Suite 105
Chamblee, Georgia   30341
770.454.9100

FAX 770.234.9596

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Student's FULL LEGAL name:________________________________________________________________________________________

 

Date of  Birth:_______________________  Permit/License No.:____________________________  Expiration Date:___________________

 

Street Address:____________________________________________________________________________________________________

 

City:_____________________________________________________________  State:_____________  ZIP Code:___________________

 

Home Telephone Number:____________________ Daytime/Emergency Telephone Number(s):________________________________

 

Please circle which session this enrollment form is for:       I         II         III

 

Amount Enclosed: _________________________ Method of Payment: Check Number_____________  or  Credit Card_____________

 


Parental Email Address:_____________________________________________________________________________________________ 

 

Credit Card Number:_______________________________________________________  Expiration Date:__________________________

 

Exact Name On Card:_______________________________________________________________________________________________

 

Authorization Signature:_______________________________________________________________  Date:________________________

 

 

I, the parent of the above-referenced student of St. Pius X Catholic High School, do hereby acknowledge and agree to the following:

 

 1.  Payment for the course must accompany this enrollment and must be in the form of a check, money order, or credit/debit card.  No telephone enrollments will be accepted.  I understand that I will receive written (or email) confirmation by mail of my student's acceptance in the course.  I further understand that the maximum number of students for any session is twenty, and that there is a minimum enrollment of ten students for any session in order for the session to be held.  If the class in which I am enrolling has reached the maximum number of students, or if the minimum number of students is not met, I understand that my enrollment and my payment will be returned.

 2.  If fourteen days or more prior to the beginning of the class I decide to cancel this enrollment, I will be reimbursed fees paid, MINUS a $125.00 non-refundable deposit.  If I decide to cancel my enrollment less than fourteen days prior to the beginning of the class, I understand that I will receive no refund nor will I be allowed to transfer this enrollment to any other session.

 3.  Any type of behavioral problem with any student will result in the student being dismissed from the course.  The full tuition and any remaining classroom or in-car lessons will be forfeited.

 4.  Attendance for all thirty hours of classroom activities is required.  If a student misses three days (seven and a half hours) or less of his or her scheduled session, then he or she will be allowed to schedule a make-up session.  If a student misses more than three days (seven and a half hours) of the scheduled sessions, then he or she must start the entire classroom portion of the course over from the beginning and pay an additional $100.00.

 5.  Any student not passing the final exam with at least a score of 70% will not be issued a Certificate of Completion.  The student will be required to repeat the entire thirty hours of classroom.  An additional $100.00 fee will be required.

 6.  I understand that the state of Georgia's required Alcohol and Drug Awareness Program (or ADAP) is NOT part of this course.

 7. I understand that my student has six months to complete the thirty hours of classroom and all in-car lessons.  If my student fails to do so, I understand that the remaiing hours and the tuition paid will be forfeited, that my student will not receive any credit for the course, and that no Certificate of Completion will be issued.

 8.  Textbooks remain the property of Nathan's Driving School, Inc.  Students who excessively damage or lose textbooks will be charged $30.00.  The Certificate of Completion will not be issued until this fee has been paid.

 9.  Appointments for behind-the-wheel lessons must be canceled twenty-four (24) hours in advance or the student will be charged an additional $129.00 for the two-hour missed lesson.  This $129.00 must be paid PRIOR to any other scheduled lessons being taken or the "missed" lesson being rescheduled.

10. If you wish to pre-pay for a road test, please include an additional $50.00 (the normal price for the road test is $75.00)  with your payment and put a check mark in this space: ________  PLEASE include a copy of your student's permit along with this Enrollment Form if you are taking advantage of this prepayment price reduction.  Due to the Deparment of Driver Services rules and regulations, students who use bioptic lenses are NOT eligible to take their road tests with us. The reduced price only applies to road tests paid for with the enrollment form for a teenage driver education program.  Road tests purchased at a later time will be charged the normal fee of $75.00.  This reduced fee for the road test does NOT apply to any students who have already completed their driver education program.  We reserve the right to cancel this offer at any time.  Note:  If your student lost his or her permit and had to have it reissued, then you MUST obtain an MVR (Motor Vehicle Report) from the Georgia Department of Driver Services to verify the original issue date of the learner's permit.  We MUST have this MVR before your student will be allowed to take his or her road test.
 

11.  A Certificate of Completion will be mailed to the student approximately two weeks after the successful completion of both the thirty hours of classroom instruction and all in-car lessons.  Due to the fact that you will need the Certificate of Completion when your student goes to take their road test, please do not schedule their road test any earlier than two weeks after they have successfully completed ALL portions of the class so that you will have the Certificate in hand.  The Department of Driver Services does not need the original Certificate (although you should take it with you), so we encourage you to make copies for them as well as for your insurance company and to use when you file your Georgia income tax to qualify for the $150.00 credit.  If you lose or misplace the original Certificate, we can produce a replacement one for you for a $10.00 fee.

 

 

______________________________________________________________________      ____________________________
Parental Signature                                                                                                                      Date

 

 Note:  All information provided in this form is for the use of Nathan's Driving School, Inc. for the sole purpose of providing the service specified and will be kept confidential.  We never share or sell this information except when it is necessary to do so with the Georgia Department of Driver Services.