Enrollment Form

Student Name *

First

Middle

Last

Contact Cell Phone *

least are least

Contact Email Address *

You will receive your appointment confirmation via the email address provided within 48 hours

Parent Name (Only under 18)

Parent Phone Number (Only under 18)

Street Address *

Apt#

City *

State *

Zip Code *

Gender *

• Male
• Female

Your Age *

• Teen (Below 18)
• Adult (Above 18)

Do You Have Valid Virginia Learner's Permit? *

• Yes
• No

Availability *AnyMornings (9 AM – 12 PM)Afternoons (1 PM – 3 PM)Evenings (4 PM – 6 PM)

Not Applicable for In-Person Class

High School Name *

State N/A if not applicable

Have you completed a Driver's Education Course? *YesNo

If you are under the age of 18, please confirm that you have completed at least 45-hours of driving practice. *YesNo

If you are of age 18 years or older, please confirm that you have completed 20-plus hours of in-car driving practice, with both highway and city experience. *YesNo

Select Courses *Teen Behind The Wheel PLUS Package Under 18 ONLY: $55045-Hours PLUS Behind The Wheel Package ONLY: $2200Experienced Teenager: Behind The Wheel Under 18 ONLY: $35060 Min Class: $10020 Lessons, 1 Hour EACH: $140015 Lessons, 1 Hour EACH: $99910 Lessons, 1 Hour EACH: $7507 Lessons, 1 Hour EACH: $5005 Lessons, 1 Hour EACH: $4003 Lessons, 1 Hour EACH: $250Adult Waiver Course (18 and Over ONLY): $4508 – Hours Driver Manual (Failed 3 times) for Learner Permit: $150Re-examination Course (3 times road test fail at the DMV) Course Behind the Wheel: $500Driver Education 30- Hours Online for Teen / Adults: $1508- Hours Online Driver Improvement Course: $49.998- Hours Classroom (In-Person) Driver Improvement Course: $95.00DMV Appointment Road test: $25090 Mins parent/teen meeting: $100

Payment Method *CashCheckCredit CardZelle

NOTE: BEFORE SUBMITTING FORM READ IMPORTANT NOTES BELOW CAREFULLY.

Anything else we should know?

If you are not sure about your skill level, we offer assessments and private driving lessons to help gauge skill levels and to teach students how to drive before they begin their Behind the Wheel Instruction. For more information, you can visit the respective pages on this site, or contact us directly.

Driver's License/Learner's Permit *

Click or drag a file to this area to upload.

Please upload a copy of your Driver’s License or Learner’s Permit

Custom Captcha *

What is 7+4?

Register Now

Note

If you want to Pay Through Credit Card please continue to complete your transaction on PAY NOW.

If you’re going to Pay Through Zelle use (631) 327 – 6131.

You will receive your appointment confirmation via the email address provided within 48 hours.

Our instructor will send you a reminder email 1 week prior to your appointment.

Our instructor will call or email you 1 day before to reconfirm appointment.

If we do not receive your confirmation, your appointment will be canceled.

Same-day appointment cancellations will incur a 15% fee.