Enrollment Contract - Medical In-Car Driver Evaluation with Prescription
Central Park Driving School C1647
7115 Blanco Rd Ste 114
San Antonio, Texas 78216
(210) 344 – 4351
(210) 344-3886 FAX
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Student’s Full Legal Name:
Must be typed exactly as it appears on the student’s original birth certificate.
Student’s Date of Birth:
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Primary Phone : HomeStudent CellMom CellDad CellOther
Alternate Phone : HomeStudent CellMom CellDad CellOther
Please upload a digital image or copy of your prescription here (allowable file types: .jpg or .pdf):
All medical evaluations are scheduled by appointment only. You must call to schedule your appointment.
Length of Evaluation: 30 minutes | Course Rate: $75
DRIVER EVALUATION ENROLLMENT POLICIES
Once an appointment is made, you must cancel at least 4 hours before the scheduled appointment time in order to avoid additional fees.
TERMS OF EVALUATION
Terms are defined as follows: CONTROL – your ability to make your car do what you want it to do, OBSERVATION – your ability to see what other traffic is doing and other things that may create problems in traffic, POSITION – your ability to drive in your lane, SIGNALING – your ability to use turn signals as required.
If assistance is needed in any area of control, observation, position, attention/distraction, situational awareness, traffic perception, or judgment it is our recommendation that this individual may be considered unsafe to drive at this time.
RULES OF OPERATION & CONDUCT
A student or prospective student may be dismissed or barred from an evaluation for tardiness, drunkenness or consumption of alcohol on the premises; rude, vulgar or disruptive behavior; smoking or using tobacco products; or being generally inattentive (sleeping, reading, etc.) during an evaluation. Students terminated for violation rules of conduct may be readmitted at the discretion of the school director.
RULES REQUIRING SPECIFIC ACKNOWLEDGEMENT
I have been furnished a copy of the school tuition/fee schedule; cancellation policy; and school regulations pertaining to terms of evaluation, and rules of operation and conduct. I further realize that any grievances not resolved by the school may be forward to : Texas Department of Licensing and Regulation Driver Education and Safety, PO Box 12157, Austin, TX 78711 – (800) 803-9202 (in state only) (512) 463-6599.
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Document Name: Enrollment Contract - Medical In-Car Driver Evaluation with Prescription
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