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 and driving. Full payment is required for Online classroom registration and driving.

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

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 ($195) 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, $195, is required for enrollment in classroom sessions.             Full payment is required on or before the first day of class.

Full payment, $395, is required for students who are enrolling in the Online Driver Education Course. There is no refund.

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

30 hrs In-class & 6 hrs Behind the Wheel Instruction

$195______ (minimum deposit) $395 FULL PAYMENT _____        

 $355.50 AAA Member_______ Card#: ___________________________________

Date of classroom session you would like to be enrolled in _________Time_______

____ 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? ______________________________________________

 Online Instruction 

The AAA discount does not apply to driving only or online instruction

ONLINE CLASSROOM & DRIVING $395 _____                                                                                    WE WILL COMPLETE THE REGISTRATION WITH "I DRIVE SAFELY"

*SAMMERS DRIVING SCHOOL ALSO ACCEPTS VISA, MASTER CARD AND DISCOVER

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.