To register by mail or in person please print and complete the Application Form. You may mail it to us at: Sammers Driving School, PO Box 3361, Terre Haute, IN 47803 or you may drop it off at our office during our regular business hours. A minimum deposit is required at the time of registration for onsite classroom or online course.

If you are unable to print an application feel free to call our office and we will be happy to mail it to you or complete it over the phone.

APPLICATION FOR ADMISSION

STUDENT'S NAME

(Legal)______________________________________________________________

AGE_____ BIRTH DATE _____-_____-______

ADDRESS______________________________________________________________

CITY____________________________________________________ ZIP__________

E-MAIL____________________________________ SCHOOL___________________________________

PHONE #__________________________ PHONE#____________________________

ALTERNATE CONTACT (in case of emergency) __________________________________________________

PHONE#______________________ RELATIONSHIP_________________________________________

Cancellation Policy

Notice of cancellation of any class must be recieved 10 days prior to the start date and will result in a non-refundable $50 filing fee. The full deposit ($175) will be forfeited for any cancellations received within 9 days of or on the start date of the registered class.

In the event that your child has started the course, but is unable to finish, he or she may continue in the next session without additional fee. Otherwise, the full tuition fee is forfeited. It is also required that we notify the state of any students who do not successfully complete the driver education course or who withdraw for any reason; the driver education permit will then be invalidated.

A minimum deposit, $175, is required for enrollment in classroom or online sessions.                                                                                                                                     Balance of $220 is due  before the CDE form will be issued.

SIGNATURE__________________________

PARENT OR GUARDIAN IF STUDENT IS A MINOR------------------------------------DATE

______ Classroom Session & Behind the Wheel Instruction: November 9 (Mon/Tues 5-8) 

______ Online Course & 6 hrs Behind the Wheel Instruction 

   $175______ (minimum deposit) $395 FULL PAYMENT _____        

      WE WILL COMPLETE THE REGISTRATION WITH "I DRIVE SAFELY" and SEND YOU THE INFORMATION & CODE FOR ENROLLMENT 

Preferred Driving Location

____ Terre Haute @ 2225 Wabash Ave    ______ Brazil @ Clay County YMCA                   _____   Clinton @ SVHS

Will you be carpooling with another student? Name(s)__________________________________________________

Do you prefer to drive on the weekend or during the week? ______________________________________________

*SAMMERS DRIVING SCHOOL ACCEPTS VISA, MASTER CARD, DISCOVER, and AMERICAN EXPRESS

Name _________________________ Card #____________________________

EX. Date_________________

Amount: _____________________________ Signature_________________________________ Date____________________

Return this application with payment to: SAMMERS DRIVING SCHOOL, P.O. BOX 3361, TERRE HAUTE, IN 47803.

We will send you confirmation that we have received your application and payment.

A second letter will be mailed with CERTIFICATION OF ENROLLMENT (CDE Form) to receive your permit 3 weeks before class begins. A written test is required to obtain a permit; however the student need not have aquired a permit to begin classes.