Safety Driving School Registration Form

SSL Protected eForm. ��Secure Registration Form:

Welcome to Safety Driving NC
This online Registration portal will help you request for a driving lessons for Students or grown-ups.

Steps for registration:
- 1. Enter your basic driving lesson requirements
- 2. Choose the type of lesson and pay via our online payment system; or just bring check/cash.
- 3. You will receive an email confirming your registration.
Please select a package based on your need:
Teenager
Complete course 30 hours of classroom instructions, 6 hours of Behind-the-wheel (BTW) instruction for $550.

6 Hours Behind-the-wheel for $500.
Grown-Ups (18yrs+)
Private Lessons:
02 HR Driving Lessons for $130

Private Lessons:
04 HR Driving Lessons for $260

Private Lessons:
06 HR Driving Lessons for $390

Private Lessons:
10 HR Driving Lessons for $600
Your Information:

Are you a teenager below 18 Years? * No, I am over 18 Years
Yes, I am a teenager!
Your First Name *
Your Middle Name *

Your Last Name *
Your Age *

Your Date-Of-birth*
Your Email ID *

Your Phone *
Your Street Address *
City *

Zip-code *
Permit or license Number:
Permit Number not required for Driver-Ed Registration
Please enter your Driver-Ed Course Date
Emergency Contact Name *

Emergency Phone *

Methods of Payment:
(CASH / CHECK / Money Order / Credit-Card)

Please read and agree with the registration requirements and procedures:
1. The school will conduct the BTW instruction in a dual controlled, fully insured, covering each student enrolled in the program.
2. The total course fee is payable in advance.
3. Additional service: use of school vehicle for North Carolina DMV road test at the rate of $120.00
4. There will be a $25.00 charge for not showing up for behind-the-wheel driving instruction without a 24-hour notice.
5. There will be a $25.00 charge for all returned checks.
6. The school will complete the course within a reasonable length of time; however it cannot be held responsible for delays caused by unsafe driving conditions due to bad weather, mechanical problems, or any other reasons over which it has no control, the school will give as much notice as possible, if any delay becomes necessary.
7. Additional service: classroom instruction at the rate of $30.00 per hour
8. The school cannot and does not guarantee that the student will successfully pass the examinations given by the Division of Motor Vehicles upon completion of the course. The school does to exert its best efforts in the teaching the student to meet the requirements of the examinations.
9. Under this agreement an instructor may not provide behind the wheel training to more than thre individual students.
10. The school will not refund any tuition monies or any part thereof when actual service has been rendered.
11. This agreement constitutes the entire contract between the school and the student, and any verbal assurances or promises not contained herein shall bind neither the school not the student.
12. This school is licensed by the state of North Carolina, division or motor vehicle.

Electronic Signature:

By Signing below; I Agree that I have read and understood the provisions of this contract; this electronic signature is legally binding.

You will receive a copy of this signed document at this E-mail Address.

Enter your full legal name:
I Agree and authorize this electronic signature for the submitted document. Please send me an e-mail with this completed document and electronic signature for my record-keeping.