Student Name: _________________________________________ Student Cell #_______________________
Address: _____________________________________________________Home # ______________________
Permit # _____________________ Date Issued _____________ DOB _____________
Parent/Guardian Name: ______________________________________ Cell # (____)_____________
I hereby request that my child be enrolled in your state approved driver education program with the understanding that
he/she will be under the supervision of the school throughout the program. This agreement will be in effect for 120
days.
Fee: $350 for the fourteen required Behind the Wheel periods.
$325 if you sign up with a friend or have taken the classroom at Green Light.
General Information:
- Students eighteen years of age and under are required by the State of Virginia to complete a state approved
driver’s education program prior to receiving a driver’s license. The requirements for Behind the Wheel are
fourteen fifty minute periods of which seven periods are spent driving and seven periods are spent observing.
The requirement for the classroom instruction is thirty-six fifty minute periods.
- Payment is due upon registration.
- A full or partial refund, depending on the number of hours completed, will be made upon request only if this
school 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.
- There will be a $25.00 charge for returned checks and in the event a student misses a scheduled behind the
wheel lesson without at least twelve hours notice, there will be a fee of $25.00 for the missed appointment.
- If a student wants more then the 14 periods provided with this contract, the fee will be $45.00 per hour.
- Student has permission to drive alone with the instructors of Green Light Driving School.
I have read and understand the information provided in this contract. Parent signature is required for students under
the age of eighteen years old.
Parent Signature____________________________ Date _________________
Instructor Signature ___________________________ Date _________________
Student Signature __________________________________ Date ________________
(Required if student is eighteen years old)
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