2006 Dd Registration

Decisive Driving

Enter Desired Date: __________________________________

PO Box 1310 Rockville, MD 20849 Decisive Driving is a one-day course, conducted at Stonewall Jackson High School, Manassas, VA. This innovative program will prepare the drivers in your family for the unexpected on the highway. Behind the wheel of our slide car, learn how to correct skids you might face on wet or icy roads. Our accident avoidance simulator will develop important visual and emergency reaction skills. By learning how and why a car responds in critical situations, become a better informed, more responsible driver.

Mail To: Car Guys, Inc PO Box 1310 Rockville, MD 20849 OR Fax to 301-984-5912 Cover Sheet Not Required

OFFICE USE ONLY Entered _________ Mailed _________

2006 DD Registration

Car Guys , INC.

Policies: The cost for the one-day event is $295.00, which is due in full upon registration. Space in classes is limited to 20 participants each day. Fee includes a $100.00 non-refundable fee. Requests to cancel/reschedule/change dates within 10 calendar days of scheduled class are subject to a rescheduling fee of $50.00. No-Shows forfeit the entire cost of the course. Car Guys, Inc., the parent corporation of Decisive Driving reserves the right to cancel/reschedule a course if a minimum number of ten (10) students are not registered two weeks prior to the start date. Students under the age of 18 must be accompanied, for the entire course, by a parent or guardian. All students must be licensed (permit or permanent). Decisive Driving classes run regardless of weather. However, Car Guys, Inc reserves the right to cancel/modify/change the dates and/or course in the instance of a severe weather warning issued by the National Weather Service, or for any other emergency situation. See our website www.decisivedriving.com for more information on policies.

Student Name _________________________________________________ Parent Name ___________________________________________________ Address _________________________________________________________ City & State ____________________________________________ Zip Code _________________________ Phone (H) __________________________ (W) _________________________ (Parent e-mail) ________________________________________________________________________________________ Previous Customer? Yes / No Student Age/Date of Birth (if under 18) ________________________ Type of License: Perm _____ Restricted ______ Learners _____ Are there any medical conditions that we should know about? Yes / No If so, please describe: __________________________________________________ Make/Model of Vehicle _______________________________ Color _______________ Year ______ ABS? Y/ N Trans: Auto/Manual What types of previous driving instruction have you attended? ______________________________________________________________ Has the Student had previous accident(s)? Yes / No Where did you hear about us? ___________________________________________________________

Payment Information: (Required at time of registration.)

Billing Address if different from above:

__________________ Check or Money Order Payable to Car Guys, Inc. Enclosed

_________________________________________

__________________ Master Card / Visa / American Express / Discover

_________________________________________

PLEASE CIRCLE APPROPRIATE CARD Card Number ________________________________________________________________________ Expiration Date _____________________________ Signature (required): __________________________________________________________________________________________ Card Holder Name: ___________________________________________________________________________________________

I certify that I am at least 18 years old or are the parent/legal guardian of the above named Student. I certify that the student holds a valid driving permit and has no known physical or mental impairments that could jeopardize the Student or other by participating in this event. I agree to abide by the rules and regulations of Car Guys, Inc., regarding the conduct of this event. I understand the policies outlined above and on the Decisive Driving web site pertaining to payment and fees associated with this event. I understand that Car Guys, Inc. reserves the right to refuse any application.

_____________________________________________________________ Date ____________________________________________ Signature of Student or if Student is under 18, the Parent/Legal Guardian

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