Registration Form

Please Mail This Page To:

Please print both pages :)))

Atlantic Driving School PO Box 5635 Mohave Valley, AZ 86446 ...928-330-2254 or  928-758-0651(24/7)

You can also call in this information, to register! Classes book FAST!!!

Instructors: Gary & Glenda Webb  for information: e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.  

Class Date:_______________________

Driver Ed classroom_____, 6 hr drive _______,8 hrs drive______, 10 hrs drive time______ Traffic School_________

First & Last Name________________________________________________________________

Street_______________________________________________________________________________

City & State, zip________________________________________________________________________

Phone number:________________________________________________________________________

Cell phone number:_____________________________________________________________________

Date of Birth__________________________________________________________________________

e-mail address_________________________________________________________________________

Credit Card #__________________________________________________________________________

Exp date_____________________________________________________________________________

Last 3 # on back of card_________________________________________________________________

How much do you want to charge?________________________________________________________

Payments include payment plans. Checks, Money Order, Master Card/Visa.(There is a $5.00 service charge for cards)  You can make advance payments as many as you want before the class. Mail to the PO Box, top of page. Gift Certificates are available.

PAYMENT POLICY/ Waiver

Traffic Survival School can be paid in advance or at the door for the class. There is a completion Certificate given to the student at the completion of class.  MVD is notified within 2 hours of that completion.

Driver Education:

Classroom or driving it is suggested to pay in advance. (Payments can be made prior to the class.) But it is possible to pay for the service at the time of that service.  If you pay in advance for that service and do not attend the class or drive time.  We will hold the money and do the service in the future for one year of the date of payment.  Atlantic Driving School will call you 3 times by phone with the number that you provided to reschedule the service.  After that, you are responsible to contact us.  Atlantic Driving School cannot legally guarantee that you will learn the correct skills for the classroom or driving skills.  But we have a VERY high percentage that do. 

Refunding: If you request a refund for services paid for but have not received.  We will subtract a 25% charge of the total cost paid as a handling fee and mil you the difference.

In no event shall Atlantic Driving School be liable for any consequences or incident damages due to the instructions, classroom or in car,  The total liability of Atlantic Driving School shall not exceed the total paid to Atlantic Driving School for services rendered.

 

I agree that the actual fees paid on my signed invoice reflect this limited liability and allocation of risk.

 

Signature                                                              Date

If under 18 must be signed by parent or legal guardian.

This form MUST be brought to your first session.

 

 

 

 

Atlantic’s School cars are:

All cars are white 4-door,2013 Ford Focus & 2012 Chevy Sonic Sentra,

Look for the yellow roof sign!