Precision Driver Training School - Application

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

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

Address:_____________________________________________________________________
E-mail 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 - Essex - Newport - Other:__________________

Please snail mail to:

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

Refund Policy: The $200 deposit is not refundable. The balance of the tuition may be refunded to students who pay the full amount of tuition prior to the first class and choose to withdraw on or prior to the first class. Refunds will not be issued after the second day of class.