(make checks payable to) MAD-AREA DRIVING SCHOOL 
copy and paste this application into your email then send here jkapinus@madareadriving.com
Send to

913 Lorena Pkwy     
Madison, WI 53713-3373
Knowledge Score: _____________
Signs Score:___________________

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 PACKAGE: $420.00 I agree to pay $120.00 as deposit and remainder of $300.00 on the first day of class for
A complete course of driving instruction including:
    30 hours of class, 6 hours of observation and 6 hours of behind the wheel instruction.
[] BEHIND THE WHEEL ONLY: $330.00 -including 6 hours of observation and 6 hours of behind the wheel instruction.

Please make check /money of deposit 120.00 along with this application
to Mad-Area Driving School to secure a place in the requested class. The remaining $300.00 is due on or before the first day of class

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.
..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 $30.00 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: 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