TEEN-AGED APPLICATION AND AGREEMENT
PRINT AND FILL OUT THIS FORM
                  -OR-
CLICK HERE TO APPLY ONLINE
(make checks payable to) MAD-AREA DRIVING SCHOOL 
Send to

913 Lorena Pkwy     
Madison, WI 53713-3373
COOPERATIVE DRIVER TESTING PROGRAM (CDTP)
Knowledge Score: _____________
Signs Score:___________________

Appointments/Questions     (608) 345-9598 8am-10:00am or 4pm-5:30pm Mon.-Fri.         
please complete the following information


Parent Name: ___________________________ Date: __/__/___  Parent Phone #____________ Email: ____________________
Student Name: ______________________ Birth Date:  __/__/___  Student Phone #___________ Email: ____________________
Address:______________________________________ ______

I (we) hereby make application to MAD-AREA DRIVING SCHOOL.  Contract No.______________  

 COMPLETE PACKAGE ONLY: $525.00 -including 30 hours of class, 6 hours of observation and 6 hours of behind the wheel instruction.
        Please register and pay online!
[] BEHIND THE WHEEL ONLY: $435.00 -including 6 hours of observation and 6 hours of behind the wheel instruction.
Please make check /money order along with this application to Mad-Area Driving School to secure a place
[] ADDITIONAL BEHIND THE WHEEL: $75.00/hr
To meeet course requirements and to avoid an additional $40.00 fee, both classroom and behind the wheel must be completed within 10 months of online or traditional classroom start date.
ATTENTION: BECAUSE OF THE UNSTABLE GAS PRICES WE WILL BE CHARGING AN EXTRA $2.00 FOR EACH DOLLAR INCREASE AT OR ABOVE $4.50 PER GALLON AT THE KWIK TRIP. THIS FEE WILL NEED TO BE PAID AT EACH BEHIND THE WHEEL LESSON.
NOTICE: DRIVING IS A HIGH RISK/ADULT ACTIVITY..
..Therefore any student who demonstrates a lack of maturity, or respect for the privelidge to drive, through continued disruption or misbehavior, will be dismissed from class.

Due to the inconvenience to the other scheduled/paired students,  In addition to the above; 
-I also agree to pay $30.00 for each missed b-t-w appointment or cancellation not called in 48 hours in advance.
Please no Voicemails or emails, direct communication or text messages only. We reserve the right to delay or reschedule service.
This agreement constitutes the entire contract between the driving school and the student, and no verbal statement of promises 
will be recognized.  The school will not refund any tuition or part of tuition if the school is ready, willing, and able to fulfill its part
of the agreement as stated .   Note: your return email address will act as verification of your electronic signature you may type in your electronic signature

_______________________________        
 Signature of Student                                                         

___________________________________     ______________________________________     
 Signature of Parent/Guardian                                  Signature of Driving School Representative