NControl Driving School - Adult Client Enrollment

Adult Client Enrollment

Please complete the following enrollment form. Please note that the * indicates required field.
Your credit card is required but will NOT be processed until dates have been scheduled. Upon submitting the enrollment form, your credit card information is encrypted and secured.

Adult or Independent Student

*First Name

*Middle Name

*Last Name

Nickname

*Address

Address Line 2

*City

*State

*Zip

*Major Cross Streets (example: Val Vista & Ray)

*Birth Date

*Gender

*Mobile Phone

*Home Phone

*Preferred Phone #

*Emergency Contact

Permit #

*Email

Expiration

Additional Email

DATE ELIGIBLE FOR LICENSE

*Any Medical or Health Concerns? Glasses or Contacts?

*Driving Experience

*How did you hear about us?

*Availability

Reason For Taking Course

CANCELLATION POLICY

I have read and answered the questions to the best of my ability. I understand that the deposit is non-refundable, non-transferable and valid for one year. If a cancellation or scheduling change is requested within 72 hours of the scheduled date, there are rescheduling fees as follows: $75 rescheduling fee for driving sessions, Car Control Clinic, Same day cancellations or No Shows will be $100 fee. NO REFUNDS for payments made or payment in full. I have read and agree to the cancellation policy and understand that by checking the box and entering my name as an electronic signature below, this is a contractual and legally binding agreement.

I Agree to the Terms

I have read and agree to the cancellation policy and understand that by entering my name as an electronic signature below, that this is a contractual and legally binding agreement.

Credit Card Details

*Credit card information is required upon enrollment. The credit card will NOT be processed until dates have been scheduled. We accept Visa, MC, Discover and American Express.