Correspondence Driver Education Enrollment Forms Please complete each of the forms below to finalize enrollment within our program. Please be aware this electronic submission is a binding contract for our program. Thank you so much for choosing US! (You will only need to submit each form once.) Student Registration Form Full Name (First, MI, Last(required) Address, City, State, and Zip(required) Student email address(required) Student Birthdate(required) Parent/Guardian Name, Phone Number, and Email(required) Emergency Contact Name & Number(required) Student Height (ft./in.)(required) Eye color(required) Weight(required) Gender (M/F)(required) Curriculum Needed (Electronic/Paper)(required) Student's High School(required) How did you hear about us? (Friend, Facebook, Website, Twitter, etc.)(required) Submit Δ Parent/ Student Enrollment Contract (Parent Initial the following): A payment of $100 is due at the time of enrollment via payment at the http://www.whiteknucklesinstitute.com website. (required) It is the responsibility of parent and student to provide 50 logged hours of driving experience that includes 10 hours at night) on an official GDL log, which can be obtained at the above provided website. Student must obtain a Learner Permit before any driving can be logged. School will provide referral card for student to obtain Learner Permit at MVD once the student has complete the Unit 2 quiz scoring 80% or above(required) The instructor cannot and does not guarantee that the student will successfully pass the examination given by the Motor Vehicle Department upon completion of the course. (required) If the Certificate of Completion or Learner Permit Voucher are lost/damaged a $40 cash or money order fee will be assessed to replace(required) I understand that the course must be completed within 2 months of submission of these forms. If not completed a further $20 per month fee will be assessed prior to receiving certificate of completion.(required) I understand that the course must take a minimum of 2 weeks for each student. If students complete sooner they will be asked to review material and certificates of completion will be mailed out at that two week mark.(required) Students please read and initial each line below. By initialing you are indicating you agree and understand the statements listed below. Student is fully responsible for completing the full course within the one year period following enrollment of the program. (required) The student is responsible for passing the final exam with a minimum of 70% to successfully pass this course and earn Final Completion Certificate.(required) It is the responsibility of student and parent/guardian to log driving experience on the official driving log printed from the website. Student must obtain Learner Permit before any driving hours can be logged. School will provide referral card for student to take Learner Permit Test at MVD. (required) I understand that the course must be completed within 2 months of submission of these forms. If not completed a further $20 per month fee will be assessed prior to receiving certificate of completion.(required) No refund is provided once curriculum for the course is download or emailed to student. I have read and understand this contract and agree to abide by the conditions and terms of this contract. I hereby request/give permission for my son/daughter to be enrolled in this driver’s education program provided by White Knuckles Institute, LLC. (required) Students Full Name(required) Students email address:(required) Submit Δ Share this:TwitterFacebookLike this:Like Loading...
White Knuckles Institute 