Utah Driving School / Student Record
Learner permit #______
Student: Fill out the information below, then read and sign the back of this form.
PLEASE PRINT
______
Legal Name (Last) (First) (Initial)
Address: ______
City: ______State: ______Zip: ______
Home Phone: ( ) ______- ______
Cell Phone: ( ) ______- ______
Birth Date: ______- ______- ______Age: ______
Month Day Year
High School / College currently attending: ______
How did you find out about UtahDrivingSchool:______
FOR OFFICE USE ONLY
Tuition:______
Date Amount/Type of Payment Receipt #
ObservationDriving Instruction
Date ______-______-______Date ______-______-______
Start / End Time______/ ______Start / End Time______/ ______
Teacher______Teacher______
ObservationDriving Instruction
Date ______-______-______Date ______-______-______
Start / End Time______/ ______Start / End Time______/ ______
Teacher______Teacher______
ObservationDriving Instruction
Date ______-______-______Date ______-______-______
Start / End Time______/ ______Start / End Time______/ ______
Teacher______Teacher______
CLASSROOM INSTRUCTION
Day #1Day #2Day #3
Date ______-______-______Date ______-______-______Date ______-______-______
Instructor______Instructor______Instructor______
Location______Location______Location______
Signature______Signature______Signature______
Day #4Day #5Day #6
Date ______-______-______Date ______-______-______Date ______-______-______
Instructor______Instructor______Instructor______
Location______Location______Location______
Signature______Signature______Signature______
Day #7Day #8Day #9
Date ______-______-______Date ______-______-______Date ______-______-______
Instructor______Instructor______Instructor______
Location______Location______Location______
Signature______Signature______Signature______
Utah Driving School
To Be Seen and Signed by Parents!!!
This agreement is between UtahDrivingSchool and
Name______
Student Printed Name
The student agrees to pay to UtahDrivingSchool the total tuition of the current school rate ($ 285.00 ). An additional penalty fee of $25.00 will be charged to the student if he/she is absent from a scheduled behind-the-wheel driving appointment. An additional penalty fee of $25.00 will be charged to the student if he/she is absent from a scheduled observation. If the student misses two appointments his/her tuition will be forfeited and the student fails the course. Cancellation may be done by contacting Utah Driving (1-801-709-7611) and leaving a message no less than 24 hours in advance of your scheduled appointment.
The student may not commence Instruction before reaching 15 years of age.
Before the student can schedule drives and observations, Utah Driving is required to visually inspect the learner permit. A legible copy can be presented in person, by fax (1-801-756-1448), or by email to . The student can schedule drives before and after classroom participation, or by contacting Utah Driving at the preceding information.
It is your responsibility to check all ID requirements for the State of Utah before registering with Utah Driving.
Utah Driving has no tolerance for student consumption of alcohol, drugs, or any chemical that may interfere with your performance behind the wheel. Any indulgence while participating in this program will result in immediate dismissal with no refund.
Student may request a refund if they withdraw within one week of registration. A $50.00 service charge will be assessed, in addition to any behind-the-wheel observation costs incurred before withdrawal. Utah Driving charges $40.00 for any bounced check(s).
Utah Driving provides the student 18 hours of classroom instruction. Utah Driving will provide the six (6) hours of behind-the-wheel instruction, and the six (6) hours of observation of student drivers. There is no guarantee of the student passing the State driving and written tests. Upon completion of the course, the student will receive the State Certificate of Completion in his/her name.
Students must complete the course within one (1) year to the date of registration. If the course is not completed, the student must repay the full registration fee and start the course over.
I, the student, agree to and understand the terms of this agreement.
Student Signature: ______
Parent Signature: ______
This copy must be signed by both the student, and parents, if the student is under 18 years of age.
Utah Driving School
Contact Information:
Phone Number: 1-801-709-7611 Fax Number: 1-801-756-1448