ENROLLMENT FORM FOR THE
TEENAGE DRIVER EDUCATION COURSE

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 Boulevard - Suite 105
Chamblee, Georgia   30341
770.454.9100

FAX 770.234.9596

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Student's FULL LEGAL name:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Date of  Birth:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ  Permit/License No.:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ  Expiration Date:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Street Address:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

City:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ  State:ˍˍˍˍˍˍˍˍˍˍˍˍ  ZIP Code:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Home Telephone Number:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ Daytime/Emergency Telephone Number(s):ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Please indicate which session number this enrollment form is for: ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Amount Enclosed: ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ Method of Payment: Check Numberˍˍˍˍˍˍˍˍˍˍˍˍˍ  or  Credit Cardˍˍˍˍˍˍˍˍˍˍˍˍˍ

Parental Email Address:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ 

Credit Card Number:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ  Expiration Date:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Exact Name On Card:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

Authorization Signature:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ  Date:ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ

I, the parent of the above-referenced student, 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 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-five, and that there is a minimum enrollment of fifteen 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 seven days or more prior to the beginning of the class, I decide to cancel this enrollment, I will be reimbursed $324.00 for the basic thirty and six program (or $554.00 for the thirty and ten program; $824.00 for the thirty and fifteen program; $1,074.00 for the thity and twenty program; or $1,874.00 for the thirty and forty program).  The remaining $125.00 represents a non-refundable deposit.  If I decide to cancel my enrollment less than seven 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 one day (six hours) or more 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 of the (seven and a half hours) 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 the six (or more hours) of in-car lessons.  If my student fails to do so, I understand that the remaing 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.

ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ      ˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍˍ
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.