Application Teenage Driver Education Program
Please print out the application, fill out and send back to us.

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Last Name / First Name / Middle Init.

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Address

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City / County / State / Zip

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Home phone / Parent's name & work phone

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Birthdate / Age / M-F


Class starting date________________Time___________
Options (select one) A B C D
COURSE OPTIONS AND TUITION
A. 30 hours of classroom instruction and EIGHT private 45 minute lessons in an AUTOMATIC.
For students with little or no driving experience.
$364.00
B. 30 hours of classroom instruction and SIX private 45 minute lessons in an AUTOMATIC.
For students with some driving experience.
$349.00
C. 30 hours of classroom instruction and SIX private 45 minute lessons in an AUTOMATIC - AND TWO private 45 minute lessons in a STICK SHIFT.
$404.00
D. 30 hours of classroom instruction and EIGHT private 45 minute lessons in a STICK SHIFT.
$429.00
As well as offering defensive behind-the-wheel instruction, Kirshner also offers PRIVATE instruction, one (1) student at a time. Additionally we offer home pick-up service for in -car lessons. (Circle "yes" for "PICK-UP SERVICE" and add $20.00 per driving lesson to the tuition fee.)
 
INSTRUCTION PERMITS
The school will issue a waiver form to students on the first day of class. The student then takes the waiver with a parent or legal guardian, two pieces of ID, and $5.00 to any Department of Licensing. They will issue the instruction permit. Be sure to have permit in hand by the second week of class. If you are 15 ½ years old you can get a permit by going to the Department of Licensing with a parent or guardian and ID and taking the written test. If you are just 15 you will need a waiver form from the school in order to get the instruction permit. The permit waiver may not be obtained before the first day of class.
 

** A Traffic Safety Education Certificate will be issued to you upon successful completion of our course. This certificate allows you to test with the Department of Licensing to qualify for a driver's license.

TERMS: We prefer payment in full. If making payments, add $10.00 to the tuition, which is due on the 11th class session.

  • A $150.00 deposit is required with each enrollment to reserve a place in class. The remaining balance is due on the opening session (to avoid the $10.00 fee).
  • Please print and mail the application, together with your deposit, to:

    P. O. Box 95565
    Seattle, WA 98145-2565

  • A $25.00 no-show penalty will be charged for all driving appointments which are not cancelled 24 hours prior to the appointment. (Call (206)-525-0909 between 9am and 5pm, Monday-Friday, to cancel scheduled driving lessons.) There are no refunds after the 2nd night of class.
  • $25.00 will be deducted from all refunds to cover administrative costs.

Make checks payable to Kirshner Driving School
Mail to: P. O. Box 95565 Seattle, WA 98145-2565


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PARENT/GUARDIAN SIGNATURE



FOR OFFICE USE ONLY

Amount paid______________Bal:______________Date:________

Receipt#_________________Referred By:___________________