Driver Education Student Enrollment Contract

Provider Information

Provider License # *

License number is required (format starts with C).

Provider Business Name (as printed on license) *

Business name is required.

Provider Email Address *

Enter a valid email address.

Provider Phone # *

Enter a valid 10-digit phone number.

Provider Business Address *

Address is required.

City *

Required.

State *

2-letter state code.

ZIP Code *

Enter a valid ZIP code.

Student Information

Printed Full Legal Name of Student *

Student name is required.

Date of Birth *

Student must be 14 to under 25 years old.

Learner License #

Student Email Address

Enter a valid email address.

Student Phone #

Enter a valid 10-digit phone number.

Student Mailing Address *

Address is required.

City *

Required.

State *

2-letter state code.

ZIP Code *

Enter a valid ZIP code.

Parent / Legal Guardian Information

Required if the student is under 18.

Printed Full Legal Name of Parent/Legal Guardian

Parent/guardian name is required for minor students.

Parent Email Address

Enter a valid email address.

Parent Phone #

Enter a valid 10-digit phone number.

Parent Mailing Address

City

State

ZIP Code

Course Selection

Choose the course type *

Classroom Only

Behind-the-Wheel Only

Full Course (Classroom + BTW)

Please select a course type.

Payment Schedule

First Payment ($) *

Date

Administrative Expenses ($, up to $50)

Cannot exceed $50 per Texas regulation.

Second Payment ($)

Date

Total Course Tuition ($)

Third Payment ($)

Date (final payment must be received before graduation)

Additional Fees (optional)

Duplicate Certificate of Completion Fee ($)

Additional Fees Total ($)

Schedule

Classroom Instruction Begins *

Start Time *

Expected End Date *

End date must be after the start date.

Make-up / In-Car Completion Deadline *

Deadline must be on or after the expected end date.

Parent's Initials Concerning Dates *

Initials required.

Policies & Acknowledgments

Attendance and Make-up Policy

A full hour of absence is charged if the student does not attend the full 55 minutes of a 60-minute instruction period. The student is responsible for making up missed time.

Parent's Initials *

Grading Policy

Mastery is a prerequisite to a grade of 70 or above, evidenced by unit tests, written assignments, skills checklists, and/or comprehensive exams.

Parent's Initials *

Rules of Operation and Conduct

Students may be dismissed for tardiness, alcohol use, disruptive behavior, tobacco use, or inattentiveness. Partial completion does not satisfy course requirements.

Parent's Initials *

Cancellation Policy

A full refund is due if the student cancels within 72 hours of signing, or can prove enrollment resulted from misrepresentation. No full refund applies after course completion or a failing exam grade.

Parent's Initials *

Termination Policy

Refunds upon withdrawal or termination are prorated by clock hours; providers may retain up to $50 as an administrative expense and must refund the remainder within 30 days.

Parent's Initials *

Discontinued Course Policy

If course discontinuation prevents completion, all tuition and fees become refundable within 30 days of a written request.

Parent's Initials *

General Acknowledgments

Received tuition schedule & policies *

Understand DEE-964 issuance conditions *

This is the entire contract *

Acknowledge insurance coverage *

Acknowledge TDLR grievance process *

Initials if one-on-one instruction is REFUSED (optional)

Signatures

Signature of Student (18 or older) — type full name

Date

Signature of Parent/Guardian (if student under 18) — type full name

Printed Name of Parent/Guardian

Date

Signature of School Representative *

Required.

Printed Name of School Rep *

Required.

Date *

Required.

Infinity Driving School

Classroom Only Details

Behind-the-Wheel Only Details

Classroom & Behind-the-Wheel — Full Course Details

Additional Fees (optional)

Attendance and Make-up Policy

Grading Policy

Rules of Operation and Conduct

Cancellation Policy

Termination Policy

Discontinued Course Policy

General Acknowledgments