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

centralparkdrivingschool@gmail.com

 

Please enter the following information:

Student’s Full Legal Name:

Must be typed exactly as it appears on the student’s original birth certificate.

Student’s Date of Birth:

   

Driver License:       

Student’s Address:

Primary Phone :     

Alternate Phone :     

Email Address:   

 

Please upload a digital image or copy of your prescription here (allowable file types: .jpg or .pdf):

 

Course Details:

All medical evaluations are scheduled by appointment only. You must call to schedule your appointment.

 

Tuition/Fee Schedule:

BEHIND-THE-WHEEL EVALUATION

Length of Evaluation: 30 minutes | Course Rate: $75

 

DRIVER EVALUATION ENROLLMENT POLICIES

 

CANCELLATION POLICY

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 agree to pay $25.00 for a behind-the-wheel driving evaluation if I am a no show (invalid permit, no permit) or fail to cancel at least 4 hours in advance of the scheduled lesson.     
  • I agree that I must have proper license in my possession for any behind-the-wheel lesson/evaluation or lesson/evaluation will be cancelled and I will be charged $25.00.     
  • I understand that the school does not guarantee a recommendation that I maintain my license to drive.    
  • I understand that the school reserves the right to reschedule a lesson/evaluation or to make available an alternate lesson/evaluation or car in the event of inclement weather, unavailability of instructor or car, or any other factor beyond the school’s control.    
  • I understand that cell phones may NOT be used in class or in the car.     

 

ACKNOWLEDGMENTS

  • This agreement constitutes the entire contract between the school and the student and no verbal assurances or promises not contained herein shall bind the school or the student.
  • This driver education school maintains business vehicle insurance as required by the Transportation Code, Chapter 601, and uninsured or underinsured coverage

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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Central Park Driving School https://www.centralparkdrivingschool.net
Signature Certificate
Document name: Enrollment Contract - Medical In-Car Driver Evaluation with Prescription
Unique Document ID: ff1ab614ca918bd06bf28f91d717a00ff36c91b1
Timestamp Audit
October 30, 2018 12:30 am CSTEnrollment Contract - Medical In-Car Driver Evaluation with Prescription Uploaded by Ernest Gutierrez - registercpds@gmail.com IP 70.123.218.164