GreenLight Co., Inc.

                                                                           GreenLight Driving School

                                                           1059 South Main Street* Cheshire, CT 06410
                                                                           Phone (203)250-8406
                                                                           Heather Carrano, Owner

Student Name: _______________________________________________________________

Sex:  M or F                Date of Birth: _______________        Phone: ____________________

Address: ___________________________________________________________

Name of Parent of Guardian: _____________________________________________

Email Address:____________________________________________________

The program consists of 30 hours of classroom instruction and eight (8) hours of behind the wheel training.  The student must be
16 years of age before starting any part of the program.    A driving permit is required by law before any behind the wheel training is
given.  The Connecticut Drivers Manual for new drivers will be covered as well as decision making and precision driving
techniques.  GreenLight Driving School does not guarantee that every student will pass the driver test when given.

The student is responsible for making and keeping driving appointments with the driving school.  There will be an extra charge of
$50.00 per driving session that is missed or not cancelled with at least 24 hours notice.  Each student must receive many
additional hours of training with another licensed adult in order for him or her to be a safe and responsible driver.  Extra hours are
available through the school for an additional $100.00 per 2 hour session.

Total Cost of Program:         $525.00
Starting date of class  :  ______________________

I hereby give consent for (name of student) ________________________ to participate in classroom and behind the wheel

Parent/Guardian Signature: _______________________________________________

Student Signature: _______________________________________________________

                                                                           Parental Information

1.        All balances must be paid in full before a student can begin driving hours

2.        GreenLight Driving School requires at least 24 hour notice for cancellation of driving hours.  There is a $50.00 charge for
driving hours that are not cancelled at least 24 hours prior to the scheduled appointment or if the student does not show up

3.        Permits must be with the student during driving hours.  In the event that a student does not have his/her permit with them,
there will be a fee of $50.00 and it will be documented as a no show.

4.        The student must complete 30 hours of classroom, which consists of 15 different lessons.  One of each lesson must be
completed. Included in the 15 classes is the 2 hour parent/teen class.

5.        The student will not be allowed into class 10 minutes after it has been started.

6.        Please pick students up in front of the building after class and on time.  GreenLight Driving School cannot be responsible for
students safety before and after class time, or if the student leaves the premises.

7.        GreenLight Driving School is not responsible for lost or stolen articles.

8.        Cell phones must be set to vibrate during class time.  There are no phone calls or text messages allowed during class

                           •        The student can and will be expelled for the following behavior:

                           1.        Pushing, shoving, fighting, or wrestling of any kind
                           2.        Shouting  or use of profanity
                           3.        Rude or disrespectful behavior
                           4.        Vandalism of any kind
                           5.        Possession of weapons, drugs or alcohol

                           •        There is a $50.00 non-refundable registration fee

•        I have read and understand the following rules and regulations for GreenLight Driving School.  I agree to abide by the above
rules and regulations as set by GreenLight Driving School.

Students Name: __________________________________________________________________

Students Signature: _________________________________________________________________

Parent/Guardian Name: __________________________________________________________________

Parent/Guardian Signature: __________________________________________________________________
Please click on the link below titled Registration and the current registration form
will open in a new window.