Lurz Driver Training
717 993-3510 FAX 717 993-5604
Kennard Dale Student Enrollment
Form
February 9, 2009 Class
Print and complete this form
and mail to the above address with your payment.
Today’s
Date _______________ Student’s Permit
Number ________________________________
Last Name ______________________ First
____________________________Middle Initial ______
Date of Birth
__________________________Home Phone ________________________________
Street Address
____________________________________________________________________
Directions/Cross Street
_____________________________________________________________
Parent Name _____________________________________
Work Phone _____________________
Date Issued Learners Permit
__________________________School Attending_________________
Concerns?
________________________________________________________________________
Is a driving test scheduled?_________
Test Date _____________ Are We to
Schedule? _________
Conditions or Limitations:
__________________________Driving Experience __________________
How did you learn about Lurz Driver Training? _________________________________________
Office
Use Only
Parent/Student Contract
TERMS AND CONDITIONS:
GENERAL: Lurz Driver Education & Training Consultants Inc. (LDET), agrees to provide basic driver training to the above named. This course of training is designed to teach a building-block process that requires home practice with a common goal toward driving proficiency. LDET cannot guarantee complete driving proficiency or a passing grade during the PennDot road test. LDET will make every effort to properly prepare a student for the task of driving an automobile. In the case of a minor child, it is the responsibility of the parent/guardian to determine the readiness of the child for driving. In the case of a licensed adult driver, LDET assumes no liability for fines or imprisonment resulting from traffic violations or traffic-related offenses or the issuance of traffic citations and/or court adjudications or dispositions resulting in fines or loss of driving privilege.
CONDUCT: All students are expected to conduct themselves properly during classroom sessions and in the car. Inappropriate language or actions or disruptions, talking or sleeping will not be tolerated and will be grounds for expulsion from the program “WITH NO REFUND”. Late arrivals to class may not be allowed entry. It is expected that students help to enhance the program by asking questions or answering when called upon. Classroom involvement is mandatory.
MISSED DRIVING APPOINTMENTS: Barring emergencies and other reasonable explanations, a $25.00 charge will be assessed for any missed appointment or no show where our office was not notified of a cancellation within a reasonable amount of time by either speaking to an office person or by leaving a recorded message on the office voice mail.
(as to conduct)