Mr. Hís Driving School, LLC

6 Tracy Drive, Derry, N.H. 03038

603-434-3050

L

Application for Enrollment

 

In conjunction with your (son or daughter) application a copy of the studentís birth certificate is required. Please note a student must be at least 15 years & 9 months old by the start of the course or 16 years old by the conclusion of the course per State Law.

 

Prior to the first day of class, a student must provide written proof that they have passed an eye test; 20/40 vision (with corrective lenses if necessary) is the State requirement. Most students arrange for this test with their high school nurse.

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A non refundable deposit of $170.00 in advance is required to secure a student in a class. The balance of $500.00 is due payable by the first class.

Mail Application form, Permission form, birth certificate and deposit check to

Mr. Hís Driving School, 6 Tracy Drive, Derry, N.H. 03038

 

Applications are accepted on a first come, first serve basis; Students are registered upon receipt of completed forms, deposit check and birth certificate.

 

PLEASE PRINT FULL LEGAL NAME

 

Name__________________________________________________________________

(First, Middle, Last)

 

Address________________________________________________________________

(Street, City, State, Zip)

 

Email Address

(class confirm. purposes)___________________________________________________

 

 

Student Home Phone_____________________ Date of Birth______________________

 

Parent Names___________________________Work Phone_______________________

Requirement: Please note (circle) the studentís after school availability for driving.

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