THAYER DRIVER EDUCATION CENTER 

DANBURY WINTER 2010 REGISTRATION

FEES:       

Fees:    Option 1            

Full Program: Eight (8) one-hour lessons by appointment and 30 hours Classroom time 

 

 $595.00

Option 2Full Program: Ten (10) one-hour lessons by appointment and 30 hours Classroom time

 $720.00
Optional – Additional services available:  
Each additional hour driving: $65.00
Off-site test processing fee only if permit is after August 1, 2008 $50.00

DMV now requires 40 hrs of on road training between parents and driving school

You may register on-line here or print this page (click here for a printable form) and mail it to:

Thayer Driver Education Center  45 Padanaram Road, Danbury, CT 06811
 

ALL CLASSES AND DRIVING HOURS MUST BE COMPLETED WITHIN ONE YEAR OF REGISTRATION

                   

  Printable Form

    

SCROLL DOWN TO CONTINUE APPLICATION
Please provide the following information:      

DANBURY WINTER 2010 REGISTRATION                                              

Full Name    Date of Birth  
Street Address   Address (cont.)
City    State/Province
Zip/Postal Code                       Social  Security Number 
Home Phone                         Cell  Phone
E-mail
Permit Number                         Permit Date

Choose the class you will be mostly attending: Use the other class for make-ups

**Classes are held Monday, Tuesday and Wednesday.**

 

Jan 4, 2010

A 2:30 - 4:30 PM

B  6:00 - 8:00 PM
March 8, 2010

A 2:30 - 4:30 PM

B  6:00 - 8:00 PM 

 

REMINDER: Payment in full is due at time of registration FEES PAID
OPTION 1: Class & 8 Driving hours $595.00

OPTION 2: Class & 10 Driving hours $720.00
Off-site test processing fee only if permit is after August 1, 2008 $  50.00
_____ Optional additional driving hours @ $65 per hour: # hrs.    x $65 =         
                                                                                 TOTAL PAID $               

Credit Card Number   

Name on Credit Card 

Expiration Date   -- mm/yy      

 

THAYER DRIVER EDUCATION CENTER

www.ThayerDriverEd.com

Phone 860-210-1333

 

PARENT AGREEMENT

You may print this form out  Printable Parent Permission Form and send or mail it in OR you may fill it out here and submit it on-line.

This health information must be received before the student has his/her first driving hour.

This health information must be returned before the student has his/her first driving hour.

I give permission for (Student’s name)   to take Driver Education classes. I understand that all scheduled driving times must be kept and that failure to keep a scheduled appointment without 24 hours advance notification will result in a charge of $35.00 per hour. Also, I understand that if my child shows up for a scheduled appointment and does not have their Learner’s Permit with them I

will also be charged a fee of $35.00 and my child will not be able to drive. In addition, I understand that all classes and driving hours must be completed within one year of registration or 3 months for Drug and Alcohol Program.

My Child has my permission to drive in a vehicle with another Student.YES NO   INITIAL

 

 

Parent's Signature      Telephone Number 

By entering your name in this box, you are bound by Federal Law Sec. 221wwab Rev.211a as if you had signed a hard copy of this document.

Print Name in box      Relationship  Enter Date  -- mm/dd/yy

Please check below any handicaps or limitations that the student may have:

Serious Illness
Hearing problems
Rheumatic fever
Vision problems
Epilepsy		 Diabetes
Fainting
Handicapped
Learning disability
Heart condition/murmur

If you have checked "Yes" to any of the above, please explain:

Does the student take any medication regularly?

Yes
No
If yes, what is it? Describe below

EMERGENCY CONTACT:       PHONE #