A+ Clark’s Driving School
7529 Huialoha St.
Honolulu, HI 96825
Please complete & mail the application & fees to the above address. We will confirm enrollment by
mail or phone. Refer to the class schedule: I want to enroll in CLASS ____________________
Copy this application for your records.
STUDENT:
LAST: ____________________ FIRST:_______________________ SCHOOL: _________________
ADDRESS:____________________________ CITY:__________________, HI ZIP_____________
PH:(R) ____________________ (C)_____________________DOB:____________ PERMIT: Yes No
PARENT/S ____________________ _______________ ______________________ _______________
FATHER/GUARDIAN PHONE MOTHER/GUARDIAN PHONE
This course includes three phases: Phase I: 30 hrs Classroom; Phase II: 6 hours BTW; Phase III Parent Observation
(40 hrs. daytime, & 10 hrs. night driving). Learners’ permit required to start Phase II & III.
I hereby give consent for my son/daughter ____________________ to enroll in the A+ Clark’s Driving School.
CLASSROOM ONLY: $200.00 + 4.5% = $209.00
BEHIND THE WHEEL: $300.00 + 4.5% = $314.00
CLASSROOM & BEHIND THE WHEEL PACKAGE: $425 + 4.5% = $445.00
MINUS $50 (SPECIAL Discount) = $395.00 (Offer ends Dec. 31, 2012).
Full payment must be received with application. Cash or check will be accepted. All returned checks will be assessed a $50 service fee.
Your canceled check is your receipt. Please make payment payable to A+ Clark’s Driving School, LLC. When confirmation for the
requested class has been made, no changes will be accepted. Fees include a non-refundable $50 handling fee.
Withdrawal and Refund Policy: Before Class Begins: Full refund, less $50 handling. If we are notified 5 working days before the first class meets.
After Class Begins: payment has been made to reserve a seat in a limited-space class. Therefore, no refunds will be made 5 working
days before the class meets for the first time. Behind-the Wheel lessons, require 24 hour notice of cancellation or rescheduling or
a $50 cancellation fee will be assessed. A+ Clark’s Driving School, LLC reserves the right to cancel or make changes to the schedule
based on low enrollment.
__________________________ ______________________________ Date: ______________
Father/Guardian Signature and/or Mother/Guardian Signature
OFFICE; Date Received by A+ _________ Check# ___________ $ ___________ Balance Due _________
Date of Confirmation: Mailed: _____________ Phoned: ____________ Who/LM: ___________________
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