Enrollment Form & Contact Us

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Contact / Enrollment Form

CONTACT INFORMATION: Owners Greg & Jodie Mangan
4609 Papermill Dr., Knoxville, TN 37909
(865) 470-4122 tel | info@drive4lifeacademy.com

TO COMPLETE ENROLLMENT:

To complete your enrollment, please submit this form and use the "BUY NOW" button on the home page to make a secure $50 deposit with any major credit/debit card.

BEGINNING DRIVER COURSE ENROLLMENT FORM
Please fill-out the following form and submit. Someone will contact you as soon as possible. You can also call us at (865) 470-4122

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
(Student) High School Name:
Drivers License/Permit Number:
Date of Birth:
Which Course Do You Want To Attend? (DATE):
In case of emergency, notify:
Emergency Contact Number (Mobile):
Emergency Contact Number (HOME):
PARENT / GUARDIAN INFORMATION	if student is under 18 yrs of age
(Parent/Guardian) First Name:
(Parent/Guardian) Last Name:
(Parent/Guardian) Address:
(Parent/Guardian) City:
(Parent/Guardian) State:
(Parent/Guardian) Email Address:
Any Known Allergies of Student::
Premium Lesson Package (30hrs classroom / 6hrs BTW) $425.00:
Additional BTW Hour Sessions @ $60.00/hr TOTAL COST:
TOTAL PAYMENT:

Completion of "Beginning Driver Course" in no way guarantees that a student is eligible, or will pass an exam for the type of license for which instruction is taken. A copy of the State of Tennessee Commercial Driver Training Enterprise Rules and Regulations are available in our office for examination by any student. If a student arrives unprepared to drive or the session is canceled by the student with less than 48 hours notice, a $25.00 charge is assessed. This constitutes the entire agreement between Drive 4 Life Academy and (DRIVE/PARENT/GUARDIAN) and no verbal statements or promises will be recognized.