By filling out this form you can have the contract prepared when you come to the first class. The school will be informed of your application, this application is to enable you to print your signup sheets and bring them to class saving you time. You also receive all available discounts, automatically ! We, at Columbus Driving Academy, would like to believe this is just the beginning of a beautiful relationship.
After filling in the form click the button [Auto-fill in forms], and then review and print it.

Eastside only. The student cannot start classes unless a parent has signed the Contract, Late-pickup Notice and Medical Release Form.

Student's Name:
Email Address:
Date of Birth: Click for Calendar pop-up (example: 01/30/2004)
Address:
City: Zip:  
County:  Other:
School:
Home Phone:  Work Phone:
Location:Bexley   Gahanna   Pickerington   Reynoldsburg
Start date: Click for Calendar pop-up (example: 01/30/2004)
Driver's permit: Yes   No 
License number: Issued Date:   Click for Calendar pop-up
Cost:$399.00 Please Note - This is your total base cost. ANY DISCOUNT OR COUPON WILL BE DEDUCTED FROM THIS AMOUNT. Only one coupon or discount per student. Coupon due on first or second class. This cost does not include the following: the $5.00 State Certificate fee and possible gas price increase fees.

By, clicking the button "Auto-fill in forms" below, you will generate a contract.
Please print, then read the directions, sign all the forms and bring them, with your deposit, to your first class.
You need to do this only once.

  

Read these Directions For Filling Out
Paperwork For Columbus Driving Academy

Please Print All the following documents,
One contract is for the school the second copy (you will get it when it prints) is for your records.

The student cannot start classes unless a parent has signed the Contract, Late-pickup Notice and Medical Release Form.

Please note:  WHEN BACKGROUNDS DON'T PRINT
On your screen, you may see the background colors that we put on our documents. But you won't see the backgrounds on paper unless you have selected the option to print background colors in the Settings or Preferences or Internet Options menu of your Internet browser software (Internet Explorer or Netscape).

Step #1 EAST SIDE CONTRACT ( Parent and Student Responsibility)

Step #2 LATE CHARGE (Parent Responsibility)

Step #3 MEDICAL RELEASE FORM (Parent Responsibility)

PAYMENTS

Total Price is $399.00

 

 

 

 

 

Resource Sheet

Organ Donor Information Kit

Recognizing the BMV is the first place many Ohioans are approached about the option of placing their name on the Ohio Donor Registry, Ohio's legislators recently mandated that driver training classes provide new drivers with the information needed to make an educated and personal decision about donation. Lifeline of Ohio, with support from the Ohio Transplant Recovery Council, was awarded a grant from the Second Chance Trust Fund to create an educational video and supplemental decision kit.

The video was distributed to all driver training schools and enterprises in the fall of 2002, and the decision kit is expected to be distributed this fall.

"We wanted the decision kit to be more than a brochure," said Brianna Abbott, Lifeline of Ohio community education coordinator. "To make it truly a €˜decision kit,' we wanted to provide students with the tools needed to make an educated decision in a clear, concise manner, while appealing to and engaging our target audience of 15-16-year-old high school students."

The kit is designed to look like a spiral-bound notebook. It uses bright
colors and is printed on lined notebook paper. Carol Greentree, account supervisor at HMS Success, the consulting firm working on the kit, said students can identify with notebooks because that's how they take notes everyday in class.

"Our experience shows to reach the target group, you must design a piece that is colorful, easy to read, draws the audience's attention and is easy to identify with," Greentree said. "By putting pictures of people their age on the cover, and by designing the kit to look and feel like a notebook, we hope it will draw the driver education students into the piece."

The slim size of the decision kit allows students to slip it in their pocket and take it home to have a discussion with their families. Abbott said the goal of the kit is to provide students and families with information they may need to make a decision about registering with the Ohio Donor Registry based on the facts of donation, and not on the common myths and misrepresentations they see on TV. "We tried to be all-encompassing when deciding which information needed to be included in the kit,"

continued

Organ Donor Information Kit

    continued
Abbott said. "There are six pull-out cards with information on the basic facts of donation, how each individual can make a difference, myths and misconceptions, common questions, how students can get more information, and what organs and tissues can be donated. After reading it, students should realize they have the ability to make an amazing difference through donation."

To bring the message closer to home for the students, three individuals share their personal stories related to organ and tissue donation in the decision kit. Since her liver transplant, Morgan Matthews, a full-time student at Ohio University, shares that she has returned to school and is looking forward to a healthy future. OSU senior split-end and tissue recipient Drew Carter tells the story of the gift a generous stranger gave to him, allowing him to return to the OSU football team and play the sports he loves. Kathy Trolio shares the story of a hero, her son, Brandon, who gave the gift of life when he died in 2001.

"Younger people sometimes don't understand the need for organ donors and the impact donation has on people's lives," Trolio said. "We have met one of Brandon's recipients and I've seen first-hand the improvement it made in his life and in the lives of his family. I share Brandon's story because I want to help others, and inspire others to donate."
The supplemental handout to go with the organ donation video is completed. It is a lapel pocket-width decision kit which has all the facts about organ and tissue donation that students and parents will need.

25 brochures in each pack. Total of 525 in each box. To order free copies for your students, contact:

Valerie Luptak at (614) 466-3250 or e-mail at vluptak@dps.state.oh.us.

Many Thanks!


May 19, 2004

I just wanted to take a moment and share with you some of the latest stats and news regarding the impact that the partnership between drivers education courses and the topic of organ donation is having on registration rates in the Ohio Donor Registry.

Prior to the inclusion of the video or the decision kit registration rates for kids under 18 averaged 53.4 percent. When the video was introduced the average registration rate for kids under 18 increased to 54.9 percent. Since the implementation of both the video and the Decision Kit the average registration rate for kids under 18 has increased yet again to 57.0 percent.

That is an increase of nearly 4 percent! A huge jump when we compare that to those receiving their driver license or id card that are 19 or over and the registration rates has averaged 47 and 48 percent in the same time frame - less than a 1 percent change.

Three weeks ago, the Decision Kit brochure that is distributed in the classes by your instructors was awarded a PRISM award by the Public Relations Society of America Central Ohio Chapter for being an outstanding piece.

I can't begin to express how much I appreciate all of the driving instructors playing a role in the effort to save lives - it truly makes a difference! I thought you might be interested in hearing how much of an impact you have been having.

Best Wishes,
Brianna
 Columbus Driving Academy East-Side
6430 E. Main St., Suite 202
Reynoldsburg, OH 43068
(614) 866-1882		 
Applicant:
DOB:
Home phone:
Address:  County:  Work phone:
City:  State:  OhioZip:  
License #:  Date Issued:  
Driver's Training to be conducted at:
High school:
County:  State:  Ohio
The Total Cost of the Course is:  $399.00
 Complete course will consist of eight (8) three (3) hour classes, for a total of twenty-four (24) unit hours; based on the Ohio Driver Training Curriculum. Eight hours (8 hours/units) of practical driving instruction. Additional instruction will cost $60.00 for Two (2) hours. A $159.00 total deposit (this includes any submitted coupon) (Discover, M/C, VISA, cash or check), is due by your first class. The balance due on the sixth in-classroom lesson attended by the student. Effective July 1, 2005 a Certificate of Completion Fee of $5.00 (cash only) must be paid on the seventh (7) class, no exceptions allowed. . A $40.00 charge will be placed on all returned checks.
The driving school shall furnish a licensed instructor, insurance and a motor vehicle for all instruction. The driving school DOES NOT guarantee the issuance of a state drivers license to the student. When a driving appointment is scheduled, the failure of a student to appear for or cancel the appointment within 24 hours in advance of the scheduled appointment, will result in a $25.00 charge. The parent/guardian and the student, will be jointly liable for this agreement in the full amount even if the course is not completed. The use of an enterprise-owned vehicle, or an independent contractor owned vehicle for the license examination is not included in the charge noted on this contract. The fee for this service is ($80.00) eighty dollars. The fee for replacing a lost or damaged Certificate is twenty dollars ($20.00) cash only at time of delivery. Any student dismissed for unruly behavior will be charged a pro-rated cost for any completed portion of the course. The entire course must be completed within six (6) months of start date. After six (6) months all classes, and associated costs, must be repeated. No extension can be made. No refund will be made to any student as long as the Columbus Driving Academy is able to fulfill its part of this agreement. All costs incurred when completing this course after the six (6) month period will be in addition to this contract. A 3% fee per month will be added to any unpaid balance after three (3). If a student fails class eight's (8) test, that student must re-take the entire class eight (8) including the test. If the student fails the test a second time, the student must schedule, directly with the main office, a time to test one-on-one with an instructor. This course will be made available by Columbus Driving Academy to be completed by:  .
Effective July 1, 2005 a Certificate of Completion Fee of $5.00 (cash only) must be paid on the seventh (7) class, no exceptions allowed.
Commercial Driving Schools are licensed by the Driver Training Program Office, 1970 W. Broad St., Columbus, Ohio 43223

I have read and understand, and have received a copy of this agreement.

C.D.A. Official:  Date:  
Student:  Date:  
Parent/Guardian:  Date:  
   
(A $40.00 fee will be charged on all returned checks) The student must have picture ID (Temporary Permit) to drive with their instructor.
There will be a $25.00 charge if a student does not have these documents at in-car lesson.
There will be a one time $10.00 surcharge, if the price of regular unleaded gas goes above $3.50 a gallon.
There will be a one time $15.00 surcharge, if the price of regular unleaded gas goes above $4.00 a gallon.
School's copy
 Columbus Driving Academy East-Side
6430 E. Main St., Suite 202
Reynoldsburg, OH 43068
(614) 866-1882		 
Applicant:
DOB:
Home phone:
Address:  County:  Work phone:
City:  State:  OhioZip:  
License #:  Date Issued:  
Driver's Training to be conducted at:
High school:
County:  State:  Ohio
The Total Cost of the Course is:  $399.00
 Complete course will consist of eight (8) three (3) hour classes, for a total of twenty-four (24) unit hours; based on the Ohio Driver Training Curriculum. Eight hours (8 hours/units) of practical driving instruction. Additional instruction will cost $60.00 for Two (2) hours. A $159.00 total deposit (this includes any submitted coupon) (Discover, M/C, VISA, cash or check), is due by your first class. The balance due on the sixth in-classroom lesson attended by the student. Effective July 1, 2005 a Certificate of Completion Fee of $5.00 (cash only) must be paid on the seventh (7) class, no exceptions allowed. . A $40.00 charge will be placed on all returned checks.
AGREEMENT
The driving school shall furnish a licensed instructor, insurance and a motor vehicle for all instruction. The driving school DOES NOT guarantee the issuance of a state drivers license to the student. When a driving appointment is scheduled, the failure of a student to appear for or cancel the appointment within 24 hours in advance of the scheduled appointment, will result in a $25.00 charge. The parent/guardian and the student, will be jointly liable for this agreement in the full amount even if the course is not completed. The use of an enterprise-owned vehicle, or an independent contractor owned vehicle for the license examination is not included in the charge noted on this contract. The fee for this service is ($80.00) eighty dollars. The fee for replacing a lost or damaged Certificate is twenty dollars ($20.00) cash only at time of delivery. Any student dismissed for unruly behavior will be charged a pro-rated cost for any completed portion of the course. The entire course must be completed within six (6) months of start date. After six (6) months all classes, and associated costs, must be repeated. No extension can be made. No refund will be made to any student as long as the Columbus Driving Academy is able to fulfill its part of this agreement. All costs incurred when completing this course after the six (6) month period will be in addition to this contract. A 3% fee per month will be added to any unpaid balance after three (3). If a student fails class eight's (8) test, that student must re-take the entire class eight (8) including the test. If the student fails the test a second time, the student must schedule, directly with the main office, a time to test one-on-one with an instructor. This course will be made available by Columbus Driving Academy to be completed by:  .
Effective July 1, 2005 a Certificate of Completion Fee of $5.00 (cash only) must be paid on the seventh (7) class, no exceptions allowed.
Commercial Driving Schools are licensed by the Driver Training Program Office, 1970 W. Broad St., Columbus, Ohio 43223

I have read and understand, and have received a copy of this agreement.

C.D.A. Official:  Date:  
Student:  Date:  
Parent/Guardian:  Date:  
   
(A $40.00 fee will be charged on all returned checks) The student must have picture ID (Temporary Permit) to drive with their instructor.
There will be a $25.00 charge if a student does not have these documents at in-car lesson.
There will be a one time $10.00 surcharge, if the price of regular unleaded gas goes above $3.50 a gallon.
There will be a one time $15.00 surcharge, if the price of regular unleaded gas goes above $4.00 a gallon.
Parent's copy

 Columbus Driving Academy East-side

Book issued:  
Student's name:
Phone:
Address:  
City:  Zip:  

  Classroom Training

Date   Start
Time 		End
Time 		Session
Number 		Films Site Student
Initials 		Instructor   State
ID #
Time  
month/day time time number  

1  2  3  4  5

B G
P R		your initials   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
     

1  2  3  4  5

B G
P R		   
Test Score #1________    Instr.:________ Test Score #2________     Instr.:________
I, the undersigned instructor certify that the student named above has received all classroom training required by Rule 4501-7-04 of the Administrative Code. 

This course must be completed within 180 days  from your start date .

  
  
Comments:

(Instructor's signature)

 
 
 
 
You may take classes one (1) through seven (7) in any order,
class eight (8) must be taken last!
Repeated classes will not count.

 

 

 

 

 

Columbus Driving Academy
6430 E. Main Street, Suite 202
Reynoldsburg, Ohio 43068
866-1882          866-3451

$40 off Web Coupon!
- Any Eastside location -

Receive $40 off the regular Teen driver's education class price
when this coupon is presented at time of student sign-up.
Limit one coupon per student.

Not valid with any other discounts.
Coupon posted on Sunday, March 4 th , 2012 6:19 pm

 

 

 

**DUE TO A RECENT PROBLEM**


****YOU NEED TO PICK-UP YOUR SON OR

DAUGHTER AFTER THE CLASS IS OVER

(9:00pm - 9:10pm). ANY PARENT THAT IS LATE

PICKING UP THEIR SON OR DAUGHTER WILL

BE CHARGED $20.00 DUE ON THEIR NEXT

CLASS. THEIR NAMES WILL BE TURNED IN

TO THE OFFICE. PLEASE SIGN AND RETURN

WITH PARENT'S SIGNATURE.


_________________________________________
Parent/Guardian signature

THANK YOU FOR YOUR COOPERATION.


Note:

 

Columbus Driving Academy
6430 E. Main St., Ste.202
Reynoldsburg, OH 43068
866-1882

Medical Release Form

This form is required before students may participate in the car portion of Drivers Education.
Student Name: Age:
Parent/Guardian
Name:
Home Phone: Work Phone:
Doctor's Name: Doctor's Phone:
Hospital
My child has the following medical conditions that may affect him/her in the car:
(example: ADDH, ADHD, Diabetes, etc.)

In the event neither parent nor the doctor listed above can be contacted, I hereby authorize the Columbus Driving Academy or his designee to obtain emergency medical care for my child when, in the opinion of a physician and surgeon license under the provisions of the Medical Practice Act, such medical care will be for the best interest of the child and should not be delayed pending consent of the parents or family doctor. I understand that Columbus Driving Academy has insurance which pays for the medical or hospital costs that might be incurred on behalf of my child while in an accident in our car.
Parent/Guardian signature:

 ________________________________________________
Parent/Guardian signature		  date: