Behind the Wheel Class Driving School Location*Driver Training Inc., Bristol VA/TN (main school)Driver Training Inc., Kingsport, TNETSU CampusSelect a Driving School LocationClass Type*$1500 - 50 Hour Log$10- Certificate replacementSpecial Needs Pricing$300 - Pass Plus Lessons, Pass Plus lessons are a good way for students to gain experience driving in different conditions. Such as, nighttime or long distance driving. Includes 4 hours.Please understand we do not administer behind the wheel lessons unless you have completed the classroom knowledge portion. You will need to show proof you have completed and passed with a private or high school transcript. Otherwise, you will be required to participate in our entire Driver Education program. HOLDING A LEARNERS PERMIT WILL NOT BE ADEQUATE. Please select the course you would like to enroll in above. A non-refundable application fee of $50.00 is included in the amounts. The prices shown are for our Bristol, TN Location only. Please call 866-981-5944 for pricing of other locations. THERE ARE NO REFUNDS AFTER 60 DAYS.Special Needs Pricing: Payment Method*Pay by PayPal , Visa, Master Card, AM EX, E-Check, etc...Unfortunately, we do not accept checks. Student InformationPlease enter "Full Legal Name"First Name*Middle NameLast Name*Date of Birth* MM DD YYYY AgeSocial Security Number*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone Number*Student's Mobile PhoneEmail* High School (if applicable)GradeDoes the student have a learner's permit or driver's license?*YesNoPermit/License Number*Date Issued* MM DD YYYY PLEASE PUT THE ORIGINAL DATE ISSUED IF YOU HAVE LOST YOUR PERMIT AND HAVE GOTTEN A REPLACEMENT LEARNER'S PERMIT FROM THE DMV.Expiration Date* MM DD YYYY Upload Learner's PermitPlease take a moment to upload a copy of your learner's permit.Parent/Legal Guardian Name (under 18 years old) Parent/Legal Guardian PhoneParent/Legal Guardian Email Please answer the following questions.Has the student experienced a physical, mental, or visual illness, injury, or condition that may affect his/her ability to operate a motor vehicle?*YesNoHas the student experienced a blackout, seizure, loss of consciousness, or fainting?*YesNoDoes the student take any medication or drug that would impair his/her ability to drive?*YesNoHas the student's privilege to drive or eligibility to obtain a Virginia Instructional Permit or Driver’s License been prohibited, suspended, or revoked by any court or the Department of Motor Vehicles?*YesNoHas the student experienced any reading or learning disabilities?*YesNoIs the student color blind?*YesNoIs the student working on the 50 hours of practice driving with 15 hours being after sunset?*YesNoHas the student experienced any signs of anxiety or is he/she overly fearful of driving or taking this course?*YesNoMaking the instructor aware of anxiety, fear, or special needs, will enable the instructor the ability to work more effectively with the student.Does the student have any other social or special needs, such as, mental conditions or deadlines and time constraints?*YesNoIf so, please explain below.CommentsTERMS OF AGREEMENT AND SCHOOL RULESTERMS OF AGREEMENTThere's a lot of important information here. Please scroll to the end to continue.TERMS OF AGREEMENT* I have read and agree to the Terms of Agreement (You must scroll through the TOA) DRIVING SCHOOL RULESThere's a lot of important information here. Please scroll to the end to continue.DRIVING SCHOOL RULES* I have read and agree to the Driving School Rules (You must scroll through the DSR) Keep up with the latest laws Yes, I would like to receive news and information via email Confirmation Email* A CONFIRMATION EMAIL WILL BE SENT TO THE STUDENT’S EMAIL ADDRESS PROVIDED DURING REGISTRATION. PARENTS, PLEASE CHECK WITH YOUR STUDENT FOR FURTHER INFORMATION. Waiver of Liability*I have read and agree to the Waiver of Liability for DTII/We expressly agree to be responsible for my own welfare/my child’s welfare, and fully assume all the risks both known and unknown associated with Behind the Wheel/In-car driving lessons with Driver Training, Inc., voluntarily and knowingly, to the fullest extent permitted by law. If signed on behalf of the child, I have discussed the risks with the child and he or she wishes to participate in the driving course nevertheless. To the fullest extent permitted by law by the parent or legal guardian of the child, including my spouse, expressly release, waive, forever discharge, and covenant not to sue Driver Training, Inc., its owner, driving instructors, or employees from and against any and all liability, claims, causes of action, costs, damages, injury, losses or suits of any and every kind which the child now has or may later have against the released parties arising out of, or related to driving in connection with Driver Training, Inc. In addition, I agree to fully protect, defend and hold harmless Driver Training, Inc. with respect to losses as a consequence of my child’s own actions or inactions whether arising from Driver Training, Inc. instructor’s negligence or otherwise. I agree that the terms of this agreement shall serve as a complete release and express assumption of risk for my child on whose behalf I am signing this agreement, including the child. It is my intention to fully assume all risk associated with Behind the Wheel training and to release Driver Training, Inc. from any and all liability to the maximum extent permitted by law.