LocationClass Dates and TimeStudent's Full Legal Name* First Middle Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Phone*Student Cell Phone*Parent Cell*Parent's Names*Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Additional Address (optional) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code High School Student Attends*How did you hear about A+?*Additional Comments/Add Coupon Code/Ask a questionPayment*Already paid through my school/community educationDistance Learning Classroom Only $250.00Down Payment $50.00 (remainder due during class)Total $0.00 Credit Card DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Parent Signature - I agree to the requirements listed below:* First Last 1. This contract expires 2 years from the first day of classroom training. All classes and BTW lessons must be completed before the expiration date. Any refund must be requested in writing before the expiration date. 2. If you choose to pay for classroom and lessons separately, the lessons will be billed at current rates. 3. Behind the wheel lesson #1 must be scheduled within 60 days of the student receiving their permit. 4. Lessons must be spread out throughout the year in various seasons (plan on approximately 1 lesson every 2-4 months). Do not wait until summer to do multiple lessons. One lesson/student allowed during June-August. 5. Students must be evaluated by an instructor prior to scheduling the subsequent lesson. Only one lesson may be scheduled at a time. Please plan accordingly for busy students. We do lessons 7 days a week. 6. Please schedule road test prior to scheduling lesson #3 (60 days in advance) and schedule the 3rd lesson at least 30-60 days prior to testing to guarantee timely completion of this program. REFUND POLICY: Registrations that are cancelled less than 7 days prior to the class start date are subject to a cancellation fee of $25. Cancellations more than 7 days from the class start date, will be refunded in full less a $10 fee for credit card refund processing fee.