Fillable Drivers Education Registration Procedures (Southern Crescent Technical College)

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Drivers Education Registration Procedures (Southern Crescent Technical College)

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Page 1 of 12
Driver’s Education Registration Procedures
All forms are to be completed and signed by a parent or legal guardian. Please check off each item as you get
it ready to send the packet back to the college. Forms must be completed in their entirety, signed returned at
least 10 days before class starts. Students who submit late documents will be dropped from the class. Also,
when registering, please ensure that you enter your child's full name, as it appears on his/her learner's permit
and not the parents/guardians name.
To Register: Complete the registration process via www.sctech.edu (Community Education section).
Complete the registration packet in its entirety. If the packet contains missing information, it will
be returned to you for completion.
Your registration for the 36 Hour Joshua’s Law - Teen Driver’s Education approved course is not confirmed
until the packet is complete. Completed Registration Packets may be scanned and emailed to
driversed@sctech.edu anytime or mailed to the address below – payment and a copy of the students permit
must be included with packet.
Parent Orientation - Plan for 30mins on first day of class.
Funding is provided by the Georgia Driver’s Education Commission (if you qualify)
Please ensure that you complete/check-off all of the following items. Incomplete packets will be denied.
Complete “ALL” highlighted spaces.
A. – If grant eligible, please indicate approval/voucher ID# on page 2.
B. – If non-grant-eligible, please remit payment of $350 where indicated on page 2.
Driver’s Education Pre-Registration Form (page 2)
Driver Training Student Contract (page 3)
SCTC Release of Claims Form (page 4)
Parent/Guardian/Student Consent Waiver (page 5 or page 6)
Student Release Form (page 7)
Off-Campus Leave (page 8)
Student Code of Conduct (pages 9 & 10)
NO-SHOW Policy and Late Pick-up Fee (page 12)
Copy of your child’s original learner’s permit (not a temporary paper copy)
Thank you and if we can be of further assistance, please do not hesitate to contact us.
Wanda Hammock
Administrative Assistant to EVP
Economic Development
706.646.6144
driversed@sctech.edu
Mail to: Southern Crescent Technical College
Economic Development
1533 Hwy 19 South
Thomaston, Georgia 30286
Southern Crescent Technical College Driver’s Education Course Locations:
BUTTS JASPER SPALDING UPSON
Southern Crescent Technical College reserves the right to cancel or reschedule classes in the event that a class does not
meet minimum enrollment requirement.
Page 2 of 12
30/6 hour Joshua’s Law Driver’s Education
Pre -Registration Form
Pre-registration is required. Classes are formed pending sufficient enrollment. Class size is limited. Completed
documents must be received 10 business days prior to the start of class to guarantee placement in class.
Should there be any changes in scheduling you will be contacted by our office.
STUDENT INFORMATION (Social Security Number -SS#)
Driver’s permit/License number (required) ______________________ Last four (4) digits of SS# _________
Student FULL Legal Name (as it appears on license) ____________________________________________
Date of Birth (mm/dd/yyyy) _______________________ Sex ___ Male ___ Female
Address___________________________________________ County of Residence _____________
Parent Phone ______________________ Parent Email ___________________________________________
High School ______________________________________________________________________
Highest grade completed (check one) ___ 9 ___ 10 ___ 11 ___ 12
PARENT/GUARDIAN INFORMATION (all information is required)
Parent’s Name(s) __________________________________________________________________
Parent’s Address (if different from above) _______________________________________________
Parent’s Phone (home) ______________ (work) ______________ (cell) _____________
Parent’s Phone (home) ______________ (work) ______________ (cell) _____________
Parent’s email(s) __________________________________________________________________
Registered Course Location & Dates: (enter date(s) of class session below)
____________________________________________________________________________________
GDEC/GOHS Scholarship Approval – Voucher ID# ____________________________________________
Voucher must be submitted when you submit your application - once application is accepted
“no” refunds will be issued.
---- OR ----
Payment Options for Non-Grant Funded Registrations:
____ Cash ____Money Order
____ Credit Card ( ) MasterCard ( ) Visa
Card Number ____________________________ Expiration Date _________ Security Code _______
Signature _______________________________________________ Date _____________________
Class Location: (select the appropriate course location)
1533 Hwy 19 South, Thomaston, GA 501 Varsity Road, Griffin, GA
1578 Highway 16 West, Jackson, GA 112 Industrial Park Drive, Monticello, GA
In case of emergency, please contact the following:
Name __________________________________________________________________
Address ________________________________________________________________
Phone ____________________________ Cell Phone ____________________________
Relationship to student ____________________________________________________
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Page 3 of 12
Driver Training Student Contract
Contract # _____________
(ALL CONTRACTS MUST BE PRE-NUMBERED AND IN DUPLICATE)
SOUTHERN CRESCENT TECHNICAL COLLEGE
1533 HWY 19 NORTH, THOMASTON, GA 30286
706.646.6144/706.646.6151
Name: _____________________________________ Dates & Times of Instruction: _____________________
Address: ___________________________________ _____________________________________________
___________________________________________ _____________________________________________
Telephone No.: ______________________________ Location of Instruction: ___________________________
Emergency Phone No.: ________________________ Type of Instruction: 30/6
Date of Birth: ________________________________ Course Fee: $__________
DL/Permit #: _________________________________ DL/Permit Expiration Date:
I, the undersigned student, agree to complete the above course of instruction for a fee of $________, consisting of 30 hours
of classroom instruction and 6 hours of behind-the-wheel instruction by the above-named GDEC Driver Training School. It is
understood that this driver training school and instructor are approved by the Georgia Drivers Education Commission (GDEC)
and that each instructor is trained by the Georgia Department of Driver Services.
The student’s successful completion of the above-named course requires each of the following:
1. Punctual attendance for all sessions.
2. Reasonable attentiveness and participation in all classes.
3. Successfully passing a written examination with a grade of at least 70.
I understand that if I fail to comply with the terms and conditions of this agreement, I am in breach of contract and the
school will not be under any obligation to fulfill the terms of this contract, and may, at its option, terminate this agreement
immediately.
It is agreed that an owner, instructor, or employee of this driver training school shall not give the impression directly or
implied to a student that upon completion of the course the student will receive a license to operate a motor vehicle.
However, immediately upon the student’s successful completion of the course as described above, the driver training school
agrees to provide a certificate of completion to the student.
This driver training school has and will maintain for the protection of the contractual rights of the student a surety bond in
the principal sum of ten thousand ($10,000.00) dollars for the students.
This agreement constitutes the contract between the above-named driver training school and the above-named student
and no verbal statements will be recognized.
__________________________________________ _______________________________________________
Signature of Student Date Signature of Authorized School Representative Date
__________________________________________
Signature of Parent or Guardian Date
RC-GDEC-DT-102 (5/15)
The Technical College System of Georgia and Southern Crescent Technical College do not discriminate on the basis of race, color, creed, national or ethnic origin,
gender, religion, disability, age, political affiliation or belief, disabled veteran, veteran of the Vietnam Era, or citizenship status (except in those special circumstances
permitted or mandated by law). Equity (Title IX) coordinator is V.P. of Student Affairs, ADA (Section 504) coordinator is V.P. of Administration. Both are located at 501
Varsity Road, Griffin, Georgia 30223, 770.228.7348/877.897.0006.
Page 4 of 12
SCTC RELEASE OF CLAIMS, WAIVER OF LIABILITY,
ASSUMPTION OF RISKS AND INDEMNIFICATION AGREEMENT
(READ CAREFULLY BEFORE SIGNING)
I hereby acknowledge that my and/or my child’s participation in Driver’s Education, a voluntary,
educational program sponsored and administrated by Southern Crescent Technical College and its Economic
Development/Continuing Education Division, involves an inherent risk of and exposure to property damage and
bodily or personal injury, including injury that may prove to be fatal, to me, to my child, or to others. Dangers
involved in this activity include, but are not limited to, heat related illnesses, hypothermia, cardiac/circulatory
problems, musculoskeletal injuries (sprains, strains, bruises, fractures, etc.), stings and bites, concussions, and
cuts/lacerations. I fully assume all risks of injury, sickness or death to me and/or my child associated with
participation in the above-stated voluntary activity, and I fully consent to my participation and/or my child’s
participation. For the sole consideration of Southern Crescent Technical College arranging for and allowing my
participation and/or my child’s participation in the voluntary program, and in connection therewith, making
available for my use and/or my child’s use while participating in such program, certain equipment, facilities,
grounds or personnel of Southern Crescent Technical College, I hereby release Southern Crescent Technical
College, and The Technical College System of Georgia, their members individually and their officers, agents
and employees (hereafter “Releasees’”) from any and all liability, claims, damages, demands, rights, and
causes of action of whatever kind, arising from or by reason of any personal injury, property damage, or the
consequences thereof, resulting from or in any way connected with my participation and/or my child’s
participation in the program. I understand and acknowledge that acceptance of this signed RELEASE OF
CLAIMS WAIVER OF LIABILITY, ASSUMPTION OF RISKS; AND INDEMINIFICATION AGREEMENT
(hereafter “Agreement”) by Releasees’ shall not constitute a waiver, in whole or in part, of sovereign immunity
by Releasees’. I further understand and agree that this Agreement shall be effective during the entire period of
my participation and/or my child’s in the above referenced program.
I understand and agree that the Releasees’ do not have medical personnel available at all times during
the program and are hereby granted permission to authorize emergency medical treatment, if necessary, for
me and/or my child, and that such action by Releases’ shall be subject to the terms of this Agreement. I state
that neither I nor my child has any health-related problems which preclude or restrict participation in this
program, and I understand that I am responsible for any and all required medical costs that may possibly result
from participation in this program.
I acknowledge and represent that I have been fully informed of the contents of this Agreement, that I
freely and voluntarily sign this Agreement, and that it is my expressed intent that this Agreement shall
contractually bind me, my child, my heirs, executors, administrators, and assigns, and my child’s heirs,
executors, administrators, and assigns.
This, the day of , 20 .
(Month) (Year)
Signature of Parent/Guardian Name of child (print)
Signature of Witness
(Must be 18 years old or older)
Southern Crescent Technical College
A Unit of the Technical College System of Georgia
Equal Opportunity Institution
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Page 5 of 12
[COMPLETE FOR ALL MINORS, UNDER THE AGE OF 18]
CONSENT BY PARENT OR LEGAL GUARDIAN FOR RELEASE OF
DRIVING INFORMATION AND WAIVER
I, _______________________________ (parent or legal guardian), hereby voluntarily consent on behalf of,
________________________(student), a minor, to the release of all information held by the Georgia Department of
Driver Services or any other federal, state or local government organization of any type, including, but not limited to, law
enforcement agencies of federal, state or local government, that relates in any way to the minor’s operation of a motor
vehicle in the State of Georgia or elsewhere. I grant this consent in furtherance of my request for the minor’s participation
in driver education activities or courses offered in conjunction with the Georgia Driver’s Education Commission, the
Governor’s Office of Highway Safety or the Technical College System of Georgia and this request applies to requests for
information submitted by any or all of said agencies of the State of Georgia.
I understand that audio, video, and GPS recording devices may be used as a part of the driver’s education course. Some of
the vehicles provided for driver education are equipped with recording devices that record audio and video inside the
vehicle cab, video facing outboard the front windshield, and GPS recording. I understand that such audio, video, and GPS
recording devices are in use and consent to their use. I further consent to GDEC, TCSG, and the driver education
provider using pictures, audio, and video, obtained from said recording devices, for training and PR purposes.
I understand that the minor’s participation in the driver education activities or courses could expose the minor to personal
or bodily injury, including death. I understand that the risks that the minor may encounter include, but are not limited to,
transportation accidents. In the event of a transportation accident, which could include bodily or personal injury, or even
death, I, as the parent or legal guardian of the minor, am responsible for all costs, including but not limited to, the costs of
medical care.
I understand, and hereby acknowledge, that the minor is not obligated or required to participate in the driver education
activities or courses offered in conjunction with the Georgia Driver’s Education Commission, the Governor’s Office of
Highway Safety or the Technical College System of Georgia. In exchange for the instruction, use of equipment, materials
and supplies by my child, and his/her being allowed to participate in this driver’s education course, I waive any and all
claims and causes of action related to the minor’s participation and hereby jointly release, acquit and forever discharge the
State of Georgia, the Georgia Driver’s Education Commission, the Governor’s Office of Highway Safety, and the
Technical College System of Georgia, their respective officers, members, directors, including its past, present, and future
subsidiaries, divisions, agencies, instrumentalities, successors, agents, servants, representatives, employees, affiliates,
partners, heirs, administrators, personal representatives, assigns, attorneys and volunteers.
This consent is given freely and voluntarily by me, on behalf of the aforementioned minor, without coercion, duress,
threat or promise of any kind and shall remain in effect for a period of ten (10) years after the date of signature below or
until revoked in writing by the minor upon the minor reaching the age of majority. Revocation of consent must be in
writing and delivered to the Georgia Driver’s Education Commission at 7 Martin Luther King Jr. Drive, Atlanta, Georgia
30334.
By signing below, I certify that I am the legal guardian of the aforementioned minor, that I am 18 years of age and am
otherwise fully competent to give this consent.
Dated at _____________________________ (location) this______ day of _______________, 201_____.
(Month) (Year)
Signature of Parent or Legal Guardian: ___________________________________
Printed name of Parent or Legal Guardian: _______________________________________
Printed name of Student: __________________________________
Student’s Driver’s License Number: ___________________________
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Page 6 of 12
Revised 10.26.15
[TO BE COMPLETED BY ALL STUDENTS OVER THE AGE OF 18]
CONSENT FOR RELEASE OF DRIVING INFORMATION AND WAIVER
I, _______________________________ (student), hereby voluntarily consent to the release of all information held by
the Georgia Department of Driver Services or any other federal, state or local government organization of any type,
including, but not limited to, law enforcement agencies of federal, state or local government, that relates in any way to my
operation of a motor vehicle in the State of Georgia or elsewhere. I grant this consent in furtherance of my request to
participate in driver education activities or courses offered in conjunction with the Georgia Driver’s Education
Commission, the Governor’s Office of Highway Safety or the Technical College System of Georgia and this request
applies to requests for information submitted by any or all of said agencies of the State of Georgia.
I understand that audio, video, and GPS recording devices may be used as a part of the driver’s education course. Some of
the vehicles provided for driver education are equipped with recording devices that record audio and video inside the
vehicle cab, video facing outboard the front windshield, and GPS recording. I understand that such audio, video, and GPS
recording devices are in use and consent to their use. I further consent to GDEC, TCSG, and the driver education
provider using pictures, audio, and video, obtained from said recording devices, for training and PR purposes.
I understand that participation in the driver education activities or courses could result in my personal or bodily injury,
including death. I understand that the risks that I may encounter include, but are not limited to, transportation accidents.
In the event of a transportation accident, which could include bodily or personal injury, or even death, I am responsible for
all costs, including but not limited to, the costs of medical care.
I understand, and hereby acknowledge, that I am not obligated or required to participate in the driver education activities
or courses offered in conjunction with the Georgia Driver’s Education Commission, the Governor’s Office of Highway
Safety or the Technical College System of Georgia. In exchange for the instruction, use of equipment, materials, supplies
and for being allowed to participate in this driver’s education course, I waive any and all claims and causes of action
related to my participation and hereby jointly release, acquit and forever discharge the State of Georgia, the Georgia
Driver’s Education Commission, the Governor’s Office of Highway Safety, and the Technical College System of Georgia,
their respective officers, members, directors, including its past, present, and future subsidiaries, divisions, agencies,
instrumentalities, successors, agents, servants, representatives, employees, affiliates, partners, heirs, administrators,
personal representatives, assigns, attorneys and volunteers.
This consent is given freely and voluntarily by me without coercion, duress, threat or promise of any kind and shall
remain in effect for a period of ten (10) years after the date of signature below.
By signing below, I certify that I am 18 years of age and am otherwise fully competent to give this consent.
Dated at _______________________________ (location) this _____ day of________________, 201____.
(Month) (Year)
Signature: ___________________________________
Printed name: _____________________________________
Date of Birth: _____________________________________
Student’s Driver’s License number: ____________________________
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Page 7 of 12
Revised 10.26.15
DRIVER’S EDUCATION CLASS
STUDENT RELEASE FORM
I, as a parent/guardian, I understand that I am responsible for my child’s actions when
he/she is driving. I will not hold Southern Crescent Technical College responsible for
any driving discrepancies/deficiencies that may occur after completing Driver’s
Education.
Student’s Name (please print)
Parent/Guardian’s Name
Signature of Parent/Guardian Date
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Page 8 of 12
DRIVER’S EDUCATION CLASS
PARENT/GUARDIAN PERMISSION SLIP
“Off-Campus” Leave
I give permission for my child, ____________________________________ to leave
campus for lunch and/or end of class on ________________________.
I understand and agree to release and forever discharge Southern Crescent Technical
College, the Technical College System of Georgia, it’s members individually, and its
officers, agents and employees, from any and all claims, demands, rights and causes
of action of whatever kind or nature, arising from my child’s activities at any time they
are off campus property.
My child will be leaving campus (lunch and/or end of class) via:
Parent/Guardian
Friend/Relative – Name ________________________________________________
Walking/ as a Pedestrian
______________________________________________
Parent/Guardian Signature
This permission slip will be kept on file, and students will be expected to adhere to these instructions.
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Page 9 of 12
Student Code of Conduct
In order to provide a harmonious learning environment at Southern Crescent Technical College, the following
student conduct code has been formulated. Any student, acting individually or in concert with others, who
violates any part of the student conduct code, shall be subject to disciplinary procedures, including dismissal
from a class session by the instructor and/or suspension or expulsion by the President or designee. Additional
rules or regulations may be initiated under established procedures during the year and, if approved, will become
effective as part of the official code at the time of inclusion.
1. Firearms, explosives, fireworks, or weapons of any kind are not to be brought onto the college premises
or to college events. (The college’s student code of conduct references Georgia laws as they relate to
weapons.)
2. The sale, attempted sale, use of, or possession of any illegal, dangerous, or controlled drugs on the
college premises or at any college-sponsored event is prohibited.
3. The sale or attempted sale of alcohol on the college premises or at any college-sponsored event is
prohibited.
4. Alcoholic beverages are not to be brought onto or used on the college premises or at other locations
where authorized college activities are held.
5. No person shall physically abuse, threaten, or intimidate any member of the faculty, staff, or student
body or any official visitor to the college. Infringement of rights of others is defined to include, but is
not limited to, the following:
a. physical or verbal abuse inflicted on another person;
b. severe emotional distress inflicted upon another person;
c. theft, destruction, damage or misuse of the private property of members of the college
community or nonmembers of the college community, occurring on campus or off campus
during any college approved activity.
d. sexual harassment.
6. The theft, damage, or malicious destruction of property belonging to the college, visitors to the college,
or any member of the college community is prohibited.
7. No persons shall assemble on campus for the purpose of creating a riot or any disruptive or disorderly
diversion which interferes with normal educational processes and operations of the college. This rule
shall not be construed so as to deny any student the right to peaceful assembly.
8. Gambling on the campus is prohibited.
9. No person shall interfere with, fail to cooperate with, or fail to make proper identification when
requested to do so by properly identified administrators or staff in the performance of their duties.
10. Unauthorized entry into or use/occupation of college facilities which are locked, closed to student
activities, otherwise restricted to use, or not reserved for use through the proper college authorities is
prohibited.
11. Falsification, alteration, fabrication, or misuse of college forms, documents, records, or identification
cards is prohibited.
12. The operation of student organizations not approved by the college administration is prohibited.
13. The dissemination on campus of publications which do not bear the name of the originator or which are
not done in accordance with college rules and regulations is prohibited.
14. Students shall not attempt to defraud, deceive or mislead an instructor in arriving at an honest grade
assessment. Initial violation of this policy may result in a lowered grade.
Page 10 of 12
15. All forms of academic dishonesty including, but are not limited to, cheating on tests, plagiarism,
collusion, and falsification of information will call for discipline. Cheating on a test is defined to
include the following:
a. Copying from another student's test paper;
b. Using material during a test that is not authorized by the person giving the test;
c. Collaborating with any person during a test without permission;
d. Knowingly obtaining, using, buying, selling, transporting or soliciting in whole or in part the
contents of an un-administered test;
e. Bribing any other person to obtain tests or information about tests; and
f. Substituting for another student or permitting any person to substitute for one’s self.
g. “Plagiarism” is defined as the appropriation of any other person's work offered for credit.
h. “Collusion” is defined as the unauthorized collaboration with any other person in preparing work
offered for credit.
16. Students shall not bring food or drinks in any area/building other than the snack bar or other designated
areas.
17. Dress Code - The following guidelines are the standards for college-wide student attire. However,
individual programs may vary in the clothing regulations to better represent the career for which
students are training and to meet appropriate safety requirements for the career area.
a. The length of any clothing will be no shorter than the bottom of the person's longest fingertip
when arms are extended to his/her side.
b. No hats or caps should be worn in class.
c. No tank tops or very short shirts. Midriff must be clothed.
d. Ragged clothes may not be worn.
e. Clothing should meet safety requirements for the program.
f. Clothing should not cause undue distractions.
g. Clothing should reflect minimum school standards and all individual program standards.
18. Tobacco Policy -The use of tobacco products, including cigarettes, cigars, pipes, or smokeless tobacco,
is prohibited on all Southern Crescent Technical College campuses except in designated smoking areas.
19. Students will exercise all safety precautions given by faculty regarding the use of supplies, tools, and
equipment. Students are not to use any equipment except under the supervision of the faculty. It is
desirable that no accidents occur; however, regardless of how minor, the student shall report incidents to
the teacher immediately. Teachers will make an incident report to the Executive Vice President of
Economic Development. All students shall help maintain safe working conditions or report any unsafe
practice(s) being conducted.
20. Every class is to clean up the training area at the conclusion of the period or day/evening. Every teacher
will have a routine for this activity and students will carry out their share of this duty with a cooperative
attitude. In addition to housekeeping in the training areas, every student will practice good housekeeping
throughout the buildings and grounds.
I have read the Southern Crescent Technical College Student Conduct Code and I understand that my/my
child’s failure to comply will result in immediate dismissal from the Driver’s Education Program without a
refund.
__________________________________________ ___________________
Parent/Guardian Signature Date
__________________________________________ ____________________
Student Signature Date
Page 11 of 12
DRIVER’S EDUCATION CLASS
STUDENT GUIDELINES
Thank you for giving us this opportunity to help your teen recognize and familiarize themselves with the
concepts of safe driving. We make every effort to ensure his/her safety throughout this program. We expect
students to govern themselves according to the rules and regulations established in the Southern Crescent
Technical College Student Code of Conduct, a copy of which is included with this packet.
Pickup Time(s)
Parents are responsible for picking up students promptly at the end of class and for lunch (if applicable). Late
fees will be charged for every 30 minutes that an instructor has to wait with a student for parents. ($25/per 30
minutes) Certificates will be held until the late fees are paid.
Lunch
Instructors will confirm specific lunch times on the first day of class during the Parent Orientation. Students
must supply their own lunch. If the student brings a lunch, someone will be on campus during this time for the
student to eat on campus. The instructor will inform the students of local eateries where applicable. Students
may only leave campus with signed parents’ permission. If students are to be picked up for lunch, allowed
to leave campus for lunch, or carpooling with another student, please let us know. There is a lunch/leave form
for parents to sign. Southern Crescent Technical College will not be held responsible for any student who leaves
the campus and has not been granted permission to do so via the lunch/leave form.
Attendance Policy
In order to receive certification, the student must complete the full 36 hours of instruction. Students are
expected to attend class every day as scheduled. We understand that emergencies happen. If a student must be
absent, please let the instructor know if possible. It is the student’s responsibility to make up any missed
time while in the course.
Textbooks
Textbooks will be issued to each student on the first day of class for the student to use. The student must return
the textbook in the same condition as issued on the first day of class. If the textbook is not returned on the last
day of class or is damaged, then the student must pay for the book. The cost is $21.00 for any textbook that is
not returned (certificates will be held until the fee is paid).
Certificates of Completion
Students must remember to keep the original copy of their certificate for the Department of Motor Vehicles and
for insurance purposes. A $10.00 fee is required before we can re-issue a certificate of completion. To avoid the
fee, you can make copies of the original certificate as needed.
Contact Information If you have any questions or concerns; please contact one of the following:
driversed@sctech.edu
Wanda Hammock, Administrative Assistant to EVP 706.646.6144
Angela Weatherford, Coordinator 706.646.6151
Steve Hendrix, Director 770.467.6072
Page 12 of 12
NO-SHOW & Late Pick-up Fee Policy
PARENTS and STUDENTS:
*Your signature and credit/debit card are required
By signing, you agree to adhere to the NO-SHOW policy which states that a $50 fee will be accessed for any
student that is a NO-SHOW, and did not call to reschedule 72 hours in advance for the course. You will not be
allowed to attend another paying course until this fee is paid.
Late fees – A $25 fee will be charged for every 30 minutes that an instructor has to wait with a student for
parents (example: parents are 1-hour late = $50 fee). The instructor allows each child to call their parents 30
minutes to an hour before they are to be picked up. Certificates will be held until the late fees are paid.
***Note: If you were issued a voucher for the course and you are a NO-SHOW your voucher becomes null and
void. In order to attend another course, you will be required to pay the full fee $350 to attend another course.
________________________________________ _______________________________________
Students Name (PRINT) Parent/Guardian Name (PRINT)
________________________________________ _______________________________________
*Student’s Signature *Parent/Guardian Signature
________________________________________ ________________________________________
Date Date
Credit/Debit Card Information (must be completed even if your child received a voucher)
Name as it appears on card ___________________________________________
Visa/MasterCard ___________________________________________________
Expiration Date _____________________
3 digit Code__________
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