Precision Driver Training School - Application

Please print clearly.
Legal Name: last:_______________________first:_______________________middle I_____

Permit # _________________________________ Date of Birth:_______/________/________

Address:_____________________________________________________________________

Age as of course ending date:_________ Your Phone # _______________________________

Person for Emergency Contact _____________________________ Phone _______________

List current medications:________________________________________________________

List any substances known to cause allergic reactions:________________________________

List relevant physical/medical conditions:___________________________________________

List relevant learning challenges:_________________________________________________

Other than above, I certify that I have no conditions that may place myself or others at risk of injury.
Applicant Signature:____________________________________________Date:__________

Parent/Guardian Signature:_____________________________________________________

Please circle the location you plan to attend. . . . Course beginning date:_________________

Morrisville - Barre - Irasburg - Winooski - Rutland - Newport - Other:__________________

Please snail mail to:

Precision Driver Training School
900 Rt. 58 W
Irasburg, VT 05845

Refund Policy: Refunds are available to students who pay the full amount of tuition prior to the first class. Withdrawals prior to the first class will be refunded the tuition price less a $100 administrative fee. Refunds for withdrawals after the first class will be calculated at 6% of the tuition for each class day beginning on the withdrawal notification date, ending on the last class day.