TEEN-AGED APPLICATION AND AGREEMENT 
(make checks payable to) MAD-AREA DRIVING SCHOOL 
ATTENTION!
We are now offering
online programs
Send to




    913 Lorena Pkwy     
    Madison, WI 53713-3373
COOPERATIVE DRIVER TESTING PROGRAM (CDTP)
Knowledge Score: _____________
Signs Score:___________________
e-mail   jkapinus@madareadriving.com     
Appointments/Questions     (608) 345-9598 10:30am-6:30pm Mon.-Fri.         
please complete the following information
Instruction area    

Date and location of class requested ________________________________________________________________________

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

I (we) hereby make application to MAD-AREA DRIVING SCHOOL.     
For  ____________ Session, beginning on ___/____/____  Contract No.______________  
 -COMPLETE TEEN PACKAGE DEALS- 
[] $420.00 I agree to pay a fee of $120.00 as deposit, and the remainder of $300.00 on the first day of class, for a complete course 
of driving instruction - 30 hours of Traditional Classroom Instruction, 6 hours observing in the car, and 6 hours of driving time, for a total 
of 12 hours of behind-the-wheel instruction.* 
*This reduced package fee is only applicable if paid in full by the first day of class.  Failure to do so will result in the application of both classroom 
($300.00) and behind the wheel ($160.00) fees totaling $460.00
.
[] $435.00 A complete course of driving instruction - 30 hours of Online Classroom Instruction, 6 hours observing in the car, and 6 hours of driving time, for a total 
of 12 hours of behind-the-wheel instruction.

[] $570.00 A complete course of driving instruction - 30 hours of Online Classroom Instruction and a total of 9 hours of driving time, with no
observation time.

-TEEN BEHIND THE WHEEL-ONLY
 [] $300.00 I agree to pay a fee of $300.00 on the first day of driving instruction for - 6 hours observing in the car, and 6 hours of driving time,
for a total of 12 hours of behind-the-wheel instruction.* 
-TEEN TRADITIONAL or ONLINE CLASSROOM -ONLY
 [] $135.00 I agree to pay a fee of $135.00 as deposit, on or before the first day of class, for - 30 hours of classroom instruction.*

 *
To meeet course requirements and to avoid an additional $40.00 fee, both classroom and behind the wheel must be completed within 9 months of online or traditional classroom start date.
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.
-($55.00  for each additional hour of behind-the-wheel sessions are available upon request.)-

Due to the inconvenience to the other scheduled/paired students,  In addition to the above; 
-I also agree to pay $20.00 for each missed b-t-w appointment or cancellation not called in 48 hours in advance. 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 you may copy and paste this into an e-mail be sure to type your name in the signature box this will constitute an electronic signature.

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

[] I was referred by ____________________________