Directions For Filling Out
Paperwork For Columbus Driving Academy

Please Print All the following documents,
One contract is for the school the second copy (you will get it when it prints) is for your records.

Please note: WHEN BACKGROUNDS DON'T PRINT
On your screen, you may see the background colors that we put on our documents. But you won't see the backgrounds on paper unless you have selected the option to print background colors in the Settings or Preferences or Internet Options menu of your Internet browser software (Internet Explorer or Netscape).

Step #1 CONTRACT (Parent and Student Responsibility)

Make sure the info provided is correct. Fill in/correct any missing/incorrect info.
Verify the spelling of your student�s name
This how it will appear on the Certificate of Completion.
Provide the license # and issue date.
- It is an alpha numeric # found on the student�s ID card or temporary permit papers.
Fill in the laws and signs test scores.
- These are found on the back of the temporary permit papers.
- If the student does not have his/her temporary papers today, please bring this information when available.
Have your student sign and date the contract.
Parent or guardian must sign and date the contract also.

Step #2 LATE CHARGE (Parent Responsibility)

Parents, read over and sign your name.
If your student has your permission to walk home, please note that at the bottom of this form and sign it.

Step #3 MEDICAL RELEASE FORM (Parent Responsibility)

Parents can fill this form out today if you have all of the necessary information or you can have the student bring this form back to the next class he/she attends.

PAYMENTS

You can pay by either Check, Charge (MasterCard or Visa), Money Order, or Cash.
Checks should be made out to Columbus Driving Academy.

Total Price is $399.00

If you choose to pay a deposit today, the amount due is $159.00.
This can be any combination of acceptable methods of payment and coupons (only one coupon per student).
If payment is not made in full, the balance is due on the sixth class (not to be confused with Class #6).
Please read the entire contract for any additional charges that may apply.

Columbus Driving Academy East-side
6430 E. Main St., Suite 202
Reynoldsburg, OH 43068
(614) 866-1882

Applicant:

DOB:

Home phone:

Address:

County:

Work phone:

City:

State:
Ohio

Zip:

License #:

Date Issued:

Driver's Training to be conducted at:

High school:

County:

State:
Ohio

Test Score:

The Total Cost of the Course is:

$399.00

Complete course will consist of eight (8) three (3) hour classes, for a total of twenty-four (24) unit hours. Eight hours (8 hours/units) of practical driving instruction. Additional instruction will cost $60.00 for Two (2) hours. A $159.00 total deposit (this includes any submitted coupon) (M/C, VISA, cash or check), is due by your first class. The balance due on the sixth in-classroom lesson attended by the student. Effective July 1, 2005 House Bill #68 has declared a Certificate of Completion Fee of $5.00 (cash only). This fee must be paid on the seventh (7) class, no exceptions allowed. . A $40.00 charge will be placed on all returned checks.
AGREEMENTThe driving school shall furnish a licensed instructor, insurance and a motor vehicle for all instruction. The driving school DOES NOT guarantee the issuance of a state drivers license to the student.
When a driving appointment is scheduled, the failure of a student to appear for or cancel the appointment within 24 hours in advance of the scheduled appointment, will result in a $25.00 charge.
The parent/guardian and the student, will be jointly liable for this agreement in the full amount even if the course is not completed.
The use of an enterprise-owned vehicle, or an independent contractor owned vehicle for the license examination is not included in the charge noted on this contract. The fee for this service is ($70.00) seventy dollars. The fee for replacing a lost or damaged Certificate is twenty dollars ($20.00) cash only at time of delivery.
Any student dismissed for unruly behavior will be charged a pro-rated cost for any completed portion of the course. The Classroom portion of the course must be completed within three (3) months of start date. The entire course must be completed within six (6) months of start date. After six (6) months all classes, and associated costs, must be repeated. No extension can be made without a valid written request, filed and accepted by the C.D.A.. No refund will be made to any student as long as the Columbus Driving Academy is able to fulfill its part of this agreement. All costs incurred when completing this course after the six (6) month period will be in addition to this contract. A 3% fee per month will be added to any unpaid balance after class #8.
This course will be made available by Columbus Driving Academy to be completed by: .
Effective July 1, 2005 House Bill #68 has declared a Certificate of Completion Fee of $5.00 (cash only). This fee must be paid on the seventh (7) class, no exceptions allowed.
Commercial Driving Schools are licensed by the Department of Public Safety through the Governor's Highway Safety Office, 1970 W. Broad St., Columbus, Ohio 43223

I have read and understand, and have received a copy of this agreement.

School Official: Date:

Student: Date:

Parent/Guardian: Date:

(A $40.00 fee will be charged on all returned checks) The student must have picture ID & white copy of temps to drive with instructor. There will be a $25.00 charge if a student does not have these documents at in-car lesson.
There will be a one time $10.00 surcharge if the price of regular unleaded gas goes above $3.10 a gallon,
a $15.00 surcharge if the price of regular unleaded gas goes above $4.00 a gallon
School's copy

Columbus Driving Academy East-side
6430 E. Main St., Suite 202
Reynoldsburg, OH 43068
(614) 866-1882

Applicant

DOB:

Home phone:

Address:

County

Work phone:

City:

State:
Ohio

Zip:

License #:

Date Issued:

Driver's Training to be conducted at:

High school:

County:

State:
Ohio

Test Score:

The Total Cost of the Course is:

$399.00

I have read and understand, and have received a copy of this agreement.

School Official: Date:

Student: Date:

Parent/Guardian: Date:

Columbus Driving Academy East-side

Book issued:

Student's name:
Phone:

Address:

City: Zip:

Classroom Training

Date	Start Time	End Time	Session Number	Films		Site	Student Initials	Instructor	State ID #
Date	Start Time	End Time	Session Number	Time		Site	Student Initials	Instructor	State ID #
month/day	time	time	number		1 2 3 4 5	B G P R	your initials
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R
					1 2 3 4 5	B G P R

Test Score #1__________ Instr.:________		Test Score #2__________ Instr.:________
I, the undersigned instructor certify that the student named above has received all classroom training required by Rule 4501-7-04 of the Administrative Code.
This course must be completed within 180 days from your start date.


Comments:		(Instructor's signature)

You may take classes one (1) through seven (7) in any order,
class eight (8) must be taken last!
Repeated classes will not count.

**DUE TO A RECENT PROBLEM**

****YOU NEED TO PICK-UP YOUR SON OR

DAUGHTER AFTER THE CLASS IS OVER

(9:00pm - 9:10pm). ANY PARENT THAT IS LATE

PICKING UP THEIR SON OR DAUGHTER WILL

BE CHARGED $20.00 DUE ON THEIR NEXT

CLASS. THEIR NAMES WILL BE TURNED IN

TO THE OFFICE. PLEASE SIGN AND RETURN

WITH PARENT�S SIGNATURE.

_________________________________________

THANK YOU FOR YOUR COOPERATION.

Note:

Columbus Driving Academy
6430 E. Main St., Ste.202
Reynoldsburg, OH 43068
866-1882

Medical Release Form

This form is required before students may participate in the car portion of Drivers Education.

Student Name:		Age:
Parent/Guardian Name:
Home Phone:	Work Phone:
Doctor�s Name:	Doctor�s Phone:
Hospital
My child has the following medical conditions that may affect him/her in the car: (example: ADDH, ADHD, Diabetes, etc.)

In the event neither parent nor the doctor listed above can be contacted, I hereby authorize the Columbus Driving Academy or his designee to obtain emergency medical care for my child when, in the opinion of a physician and surgeon license under the provisions of the Medical Practice Act, such medical care will be for the best interest of the child and should not be delayed pending consent of the parents or family doctor. I understand that Columbus Driving Academy has insurance which pays for the medical or hospital costs that might be incurred on behalf of my child while in an accident in our car.

Parent/Guardian signature:

________________________________________________

date:

In-Car Policies

All eight classroom classes must be completed before in-cars be scheduled.
Balance must be paid in full before in-cars can be scheduled. Balance may be paid by cash, check, MasterCard or Visa. If paying by check, balance must be paid by the 6th class student attends, otherwise student must wait 10 days before scheduling in-cars.
The first in-car lesson is scheduled through the office. When calling to schedule in-cars, have the following information Temporary permit number, temporary permit issue date, and scores for the temporary permit laws and signs.
The final three in-cars are scheduled with the instructor in the car.
In-car lessons must be canceled 24 hours in advance. There is a $25 fee for lessons not canceled at least 24 hours in advance.
All classroom are to be completed within a 3 month period. The entire course needs to be completed within a 6 month period. After a 6 months, the classes and payment will start over.
There will be a $40.00 charge on returned checks.

By filling out this form you can have the contract prepared when you come to the first class. The school will be informed of your application, this application is to enable you to print your signup sheets and bring them to class saving you time. You also receive all available discounts, automatically! We, at Columbus Driving Academy, would like to believe this is just the beginning of a beautiful relationship.
Student's Name:
Email Address:
Date of Birth:	(example: 01/30/2004)
Address:
City:	Zip:
County:	Other:
School:
Home Phone:	Work Phone:
Location:	Bexley Gahanna Pickerington Reynoldsburg
Start date:	(example: 01/30/2004)
Driver's permit:	Yes No	Scores:	Test score:	(found on the back of the white paper permit)
License number:			Issued Date:
Cost:	$399.00 Please Note - This is your total base cost. ANY DISCOUNT OR COUPON WILL BE DEDUCTED FROM THIS AMOUNT. Only one coupon or discount per student. Coupon due on first class. This cost does not include the following: the $5.00 State Certificate fee and possible gas price increase fees.

Directions For Filling Out
Paperwork For Columbus Driving Academy

Please Print All the following documents,
One contract is for the school the second copy (you will get it when it prints) is for your records.

Step #1 CONTRACT (Parent and Student Responsibility)

Step #2 LATE CHARGE (Parent Responsibility)

Step #3 MEDICAL RELEASE FORM (Parent Responsibility)

PAYMENTS

Total Price is $399.00

In-Car Policies

Directions For Filling OutPaperwork For Columbus Driving Academy

Please Print All the following documents,One contract is for the school the second copy (you will get it when it prints) is for your records.

Step #1 CONTRACT (Parent and Student Responsibility)

Step #2 LATE CHARGE (Parent Responsibility)

Step #3 MEDICAL RELEASE FORM (Parent Responsibility)

PAYMENTS

Total Price is $399.00

In-Car Policies

Directions For Filling Out
Paperwork For Columbus Driving Academy

Please Print All the following documents,
One contract is for the school the second copy (you will get it when it prints) is for your records.