driver education registration form

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DRIVER EDUCATION PROGRAM 2014-2015
Driver Education, Inc. & St. Louis Park High School
The 2014-2015 Driver Education Program is co-sponsored by Driver Education Inc. and St.
Louis Park High School again this year. We are the only program in the state to require our
instructors to have dual licenses through the State Department of Education and the
Minnesota Department of Public Safety. Parents can trust that their children will receive the
best training possible in this important subject.
After School 2014-2015 Course Sections
All classes will be held in Room B112 from 3:15-5:45 pm, Monday - Thursday.
Each section is 12 days in length. Day 12 is the permit test from 3:15-4:30PM.
Students only need to complete one of the sections. However, students must
attend all days of selected section. Any student age 14 or older may register.
Section 1:
Section 2:
Section 3:
Section 4:
Section 5:
September 22-Oct 9
November 10-Dec 4 (no class during Thanksgiving week)
January 26-February 12
March 2-March 19
April 27-May 14
Summer 2015 Course Sections
All classes will be held in Room B112. Classes are 10 days in length, Monday-Friday.
Students must attend all days of selected section. Any student age 14 or older
may register (including those entering 9th grade).
Section 6: June 15-26
8:00-11:00 am
Section 7: June 15-26
11:00-2:00 pm
Section 8: July 20-31 8:00-11:00 am
* Permit Test: Friday, June 27th 8:00am*
Registration and Cost
Total cost is $365: $165 down payment due with registration form. Balance of $200
due at first Behind the Wheel Lesson, once the permit test is passed.
Cost includes both 30 hours of classroom instruction and 6 hours of in-car training.
Please complete the registration form and return with a check or cash payment
to Ms. Luskey in Room B112. Make checks payable to “DRIVER EDUCATION INC.”
Or mail to: Driver Education Office, 4925 Dupont Avenue North, Mnpls, MN 55430
You can register for a session at any time during the year.
Please hurry, class size is limited!
Classroom Instructors
Bill Wodarski (billwodarski@gmail.com) 651.621.5649
Allison Luskey (luskey.allison@slpschools.org) 952.928.6241
(SEE BACK FOR REGISTRATION FORM)
DRIVER EDUCATION REGISTRATION FORM
_________________________ ______________________________ _______________________
LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
________________________________ ___________________ _________ _________________
STREET ADDRESS
CITY
ZIP
BIRTH DATE
________________________ _______________________ _______________________________
HOME PHONE
STUDENT CELL PHONE
PARENT EMAIL ADDRESS
Mark your desired session:
After School classes Monday – Thursday 3:15 to 5:45 pm for 3 weeks (12 days)
_____ Section 1: September 22-Oct 9
_____ Section 2: November 10-Dec 4
_____ Section 3: January 26-February 12
_____ Section 4: March 2-March 19
_____ Section 5: April 27-May 14
Summer classes: Monday – Friday for 2 weeks (10 days)
_____ Section 6: June 15-26
8:00-11:00 am
_____ Section 7: June 15-26 11:00-2:00 pm * Permit Test: Friday, June 27th 8:00am*
_____ Section 8: July 20-31
8:00-11:00 am
Mark Your Desired Payment plan:
_______ $365.00 full tuition payment for 30 hours of classroom and 6 hours of B-T-W.
_______ $165.00 down payment, with $200 balance due during behind-the-wheel.
Parental approval for program participation:
I hereby give my consent for ___________________ to take Driver Education at St. Louis Park High
School. I understand that my son/daughter will be taught by a certified driver education teacher
by the State of Minnesota Department of Public Safety and the Department of Education. Cars will
be furnished by Driver Education Inc. for the 6 hours of behind the wheel. There are no guarantees
that students will pass the permit test or license test. If a refund is requested, there will be a $30
processing fee the first year and a $60 processing fee the second year.
* Signature of Parent/Guardian: ______________________________________ Date: _________
Please note:
A. Choose your session carefully. Students must attend all classes in the session selected.
B. The permit test requires proper identification in the form of a Birth Certificate, U.S. Passport
or immigration papers in order to take the test.
C. No transportation is provided for the class. You must arrange pick up.
D. Any student age 14 or older can take the class, but you must be age 15 to take permit test.
E. If the cost of gas remains above $3.00 per gallon, a small fuel charge will be added to the
behind the wheel training as our vehicles are used for training.
F. If you have any other questions please call Bill Wodarski, program coordinator at 651/6215649. This is our 16th year at St. Louis Park High School and we are pleased to offer the class.
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