| Contract for Re-examination Class |
| 1924 Arlington Blvd., Suite A Charlottesville, VA 22903 434-979-5300 www.drivegreenlight.com |
Student Name: _______________________________________Home phone # _________________
Address: ___________________________________________ Cell (_______)_________________
___________________________________________
Has the student had failed the written learner's permit test 3 times ____yes ______ no (If no, how
many times______)
General Information:
- Please complete registration form and mail to address above.
- Students who have failed the Virginia Learners permit exam are required to take a class consisting of 36
fifty minute periods. - A refund will only be given if Green Light is incapable of or unwilling to perform its part of this agreement
within one hundred twenty days of registration. - The instruction provided by this school does not guarantee that any student will pass the state license
examination or that the student can secure a driver’s license or the student will be guaranteed employment
upon completion of course. - DMV is committed to providing transportation safety through the certification of quality driver training
programs. If you have comments or concerns about this course, call their toll-free number 1-877-885-5790.
I have read and understand the information provided in this contract.
Student Signature______________________________________ Date _________________
Instructor Signature __________________________________ Date ________________