NWDA Adult Class Enrollment

1658 BENTON RD, STE 600 BOSSIER CITY, LA

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- IMPORTANT INFO FOR ADULT APPLICANTS
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ADULT COURSE
ENROLLMENT FORM

PLEASE DO NOT SUBMIT THE FORM BELOW WITHOUT THE INTENTION OF PAYING THE MINIMUM REQUIRED TO RESERVE YOUR SEAT.

IN ORDER TO MAINTAIN AN ACCURATE COUNT OF RESERVED SEATS, SUBMITTED PRE-ENROLLMENT FORMS NOT FOLLOWED BY THE MINIMUM PAYMENT $155 (VIA PAYPAL or CASH AT THE BOSSIER OFFICE), WILL BE VOIDED. THIS MAY BE WITHOUT PRIOR NOTICE OR FOLLOW UP.

IMPORTANT: THE FORM BELOW
IS A REQUIREMENT OF ENROLLMENT.

ADULT COURSE ENROLLMENT FORM

* Indicates required field

CLICK DROP DOWN ARROW *

NOTE: 8-HR Behind-the-wheel portion required after completing the classroom portion.

Student Information (LEGAL NAME) *

First

Last

Please enter student's "legal name" as it is on the birth certificate (or legal custody documents).

Middle Name (See ? below) *

If you have a MIDDLE name be sure to enter it here. Enter "None" here IF you do not have a legal middle name on TIP Card (birth certificate or other legal ID submitted to OMV).

Age *

DOB *

Cell Phone Number *

Email Address *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Choose One *

"Already have TIP Card" "Have appt to get TIP Card" "Will make appt for TIP Card"

TIP CARD # (If available). *

Students are required to have the TIP card in order to take the OMV written test on the last day of class, and to participate in the Behind the wheel (driving) portion? Don't have it yet? See note below.

TIP CARD ISSUE DATE (If Available) *

Cell Number of Alternate Contact Person *

If we are unable to reach you, who may we text or call if necessary?

Check locations where student has driving experience. (Check all that apply). *

None Subdivision (i.e. neighborhood streets) Parking Lots Rural Roads In town (City streets and intersections) Highway Interstate

Willing to drive 4-hours in one day (if we have an opening)? *

YES NO

Upload PICTURE OF TIP CARD (IF AVAILABLE) *

Max file size: 20MB

NOTE: PLEASE OBTAIN YOUR TIP CARD BEFORE THE CLASS. STUDENTS WHO DO NOT HAVE THE TIP CARD MAY ATTEND THE CLASSROOM PORTION, BUT CANNOT TAKE THE OMV TEST SINCE THE TIP CARD NUMBER IS REQUIRED TO REGISTER FOR THE TEST. THE STUDENT WILL BE REQUIRED TO RETURN AT A LATER DATE FOR A SPECIAL TEST SESSION (1:1 OR SMALL GROUP) ONCE THE TIP CARD HAS BEEN OBTAINED FROM THE DMV. NOTE: SPECIAL TEST SESSION FEE IS $25 (Applies to all tests given on NON-CLASS DAYS). ALTERNATIVELY, CONSIDER WAITING FOR A FUTURE COURSE ONCE YOU HAVE OBTAINED THE TIP CARD.

DISCLOSURES: PLEASE DO NOT SUBMIT THE FORM IF... YOU ARE NOT prepared TODAY to pay at least the minimum payment of $155 REQUIRED to reserve a seat in the class. All forms not followed by the required down payment will be voided after 48 hours.

After submitting this form, you will be re-routed to the Payment Page. You may pay with a major debit or credit card, or with your PayPal account. TOTAL Fee is $450. After required Down Payment, UNPAID BALANCE ($295) is due by the morning/day of the class (before class begins). Please bring the balance in cash, exact change.

ROAD SKILLS TEST FEE: COURSE FEE DOES NOT INCLUDE THE ROAD TEST. It will be billed separately ($55).

Behind-the-wheel (BTW) schedule:
Per LA State Guidelines, we will provide a BTW schedule in which the date of your last 2-hour session will be no later than 90 days after the end of the classroom portion. Upon receipt of the schedule via TEXT MESSAGE, the student will need to respond "ACCEPT" or notify us ASAP of any dates/times that need to be revised. We do our best to accommodate students individual schedules, however, please be as flexible as possible to complete the behind-the-wheel portion as soon as possible.

Please submit Registration with the UNDERSTANDING that students enrolled in this class will be added to a BEHIND-THE-WHEEL ROSTER with students who have already taken the Adult class. Students will participate in the behind-the-wheel portion in order of date of completion of the classroom portion.

Thank you.

Northwest Driving Academy Management

Submit

Northwest Driving Academy LLC NOW WITH TWO LOCATIONS to better serve our customers:
1658 Benton Rd, Suite 600, Bossier City, LA 71111

112 W. Ark Ave, Ste 4, Vivian, LA 71082

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