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Segment 1 Contract

Program Information

Classroom Location:
Program #:
Start Date:
End Date:

Student Information

Date of Birth:
Please include city, state, and zip code in the address field.
Parent/Guardian Cell:
Student Cell:
Parent Address:
Same as student address?


Advanced Driving Academy will provide each student the following:

  • 24 hours of classroom instructions
  • 6 hours of behind-the-wheel (BTW) driving instruction
  • 4 hours (minimum) of observation time, where the student will observe another driving
  • Classroom instruction materials

Class Details:

  • Classroom instruction lasts 3 weeks (minimum); 2 hours a day (maximum), 4 - 5 days a week.
  • BTW instruction will not begin until the student has received a minimum of 4 hours of classroom instruction.
  • BTW instruction must be completed no later than 3 weeks after the classroom instruction has been completed.
  • The Student must bring birth certificate or passport to the first day.

Terms and Conditions

  1. The student must be at least 14 years and 8 months old by the first scheduled day of class. Verification by birth certificate is required.
  2. The parent/guardian agrees to pay the amount of $350 (price may vary based on time of year). We accept cash, money order, credit card, or check.
  3. The parent/guardian agrees to pay at least 50% in advance to secure class enrollment. The remaining balance must be paid by the 5th class session. If you're paying online, the class must be paid in full.
  4. The required score to pass the State Test is 70%. Additionally, students must also pass the behind-the-wheel requirements.
  5. The student must make up any class time missed. All make-up sessions must be completed no later than 3 weeks from the final class date. Any student who misses more than two classes will be required to repeat the entire program at their own expense.
  6. Advanced Driving Academy will conduct the behind-the-wheel instruction in a dual-controlled automobile that is fully insured to cover each student enrolled in the program.

ADA Policies

  • The deposit of 50% of the tuition is non-refundable. If the program is paid in full, a refund of 50% will be given if the student cancels the order at least three days before the class has begun.
  • Orders cancelled within 72 hours of the class start are subject to a $35 fee.
  • Students who reschedule, cancel, or miss a drive are subject to a $35 fee.
  • Students who miss a class session are subject to a $25 fee.

Health Assesment

  1. Is the student's visual acuity at least 20/40? Yes No
  2. Has the student had a fainting spell, blackout, seizure, or any other uncontrolled loss of consciousness in the last six months? Yes No
  3. Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely? Yes No
  4. Does the student have any mental or physical condition which would affect their ability to participate in the classroom phase or behind-the-wheel portion of this program? Yes No
  5. Does the student require special accommodations to participate in the driving phase? (ie. adaptive devices, an interpreter, etc.)? Yes No
  6. Does the student require special accommodations to participate in the classroom? (i.e., test read, interpreter, seating placement, etc.)? Yes No
Driving Waiver: Behind-the-wheel instruction is done with two students & an instructor. If unforeseen issues arise, I agree to one-on-one instruction.
Yes No
Certification: By clicking 'I agree to the Terms & Conditions' below, you certify that the information on this form is true and accurate to the best of your knowledge. Additionally, by clicking, you accept and acknowledge ADA policies detailed above and give us permission to use your son/daughter in any form of media (photos, videos, etc.) taken during the course for marketing purposes.
Notice: This driver education provider is required to be certified by the Secretary of State. If you have any complaint that cannot be settled with the provider, please complete the Driver Education Complaint form found under Driver Programs Division on the Department of State website: Completing driver education does not guarantee a driver's license.
Date of Contract:
I agree to the Terms & Conditions