Valentine’s Driving School Inc.
Teen Driver Education Online Application / Registration Information
Age Group: _____15–17
Highest Education:
Name and Location of Highest
School___________________________________________________________
Highest Grade Completed _____________ Year Graduated ________________
Professional Development:
_____ Teen Drivers Education Program
Preference Available:
Days: ____ Mon ____ Tues. ____ Wed. ____ Thurs. ____ Fri. ____ Sat.
____ Sun.
Times: _____ AM ________________________ to _______________________
PM ___________________________ to __________________________
Evening’s ________________________ to __________________________
Name___________________________________________________________
Permit License Number______________________________
Expiration______________
Phone (H) _______________ (W) _______________ (Cell) ________________
Email Address_________________________________________________________
Address_________________________________________________________ City________________________ State__________________
Zip__________________
Date of Birth________________________________
Place of Employment:
________________________________________________________________
Years of Service: _________________
Position Title: __________________________________________
Payment Method: Cash ___________ Check # __________________
Money Order __________________________ Travelers Check______________ PO # ____________________________Company________________________
If special assistance is required, please describe
________________________________________________________________
Course # Course Title Date Tuition
________ __________________________ _____________ ______________
________ __________________________ _____________ ______________
________ __________________________ _____________ _____________
Tax 4.712% $________________
Total Amount Due $ ____________
Tuition Teen Drivers Education Program $360.00 Plus Tax
Driver Education Requirements:
Teenagers under the age of 18 years old, and above 15 1/2 years old are required to complete Thirty (30) hours of Classroom Driver Education. Student also need to complete Six (6) hours of Behind- the- Wheel Session by a Certified Driver Instructor. Secondly, the State of Hawaii requires each teenager to have Fifty (50) hours of actual driving supervised by a license driver, however; ten (10) hours must be night driving. In addition, a notarized letter from the parents stating that the above-required hours of driving was met.
Upon successfully completing above requirements you will receive from our certified instructors a State of
Student must attend every classroom and behind the wheel lesson. If student misses a class he/she will need to make up the class and will be charge a fee per incident. Student must pass all test and quizzes with 80% or better. A $75.00 dollar non - refundable deposit which safes the students place in the class. However this deposit is applied to the tuition fee. We also do have payment plans.
Make-Up Sessions: If unable to attend any scheduled Instruction Student must call Instructor two hours before scheduled instruction appointment. Student will be responsible for make-up session charge of $40.00 per session. Make-up charge must be paid in cash before the next schedule instruction session.
I agree with the above information and with Valentine’s Driving School Inc. policy and rules. Please feel free to visit our web site at www.valentinesdrivingschoolinc.com
Student Signature:_________________________________________ Date___________
Parent Signature:__________________________________________ Date___________
Parent Signature:__________________________________________ Date___________