1924 Arlington Blvd, Suite A, C’ville, VA 22903
Sheila Jones – Owner
434 -979 -5300 www.drivegreenlight.com
Behind the Wheel Contract for Students 18 and Under
Student Name: ____________________________________________Student Cell #______________________
Permit # _____________________ Date Issued _______________ Home Phone #(_____)_________________
Parent/Guardian Name: _____________________________________ Cell phone # (____)_________________
How many hours of driving does student have with parent ______ School student attends ________________
Fee for Behind the Wheel: $330.00 or $310.00 (if you took classroom portion at Green Light)
Please fill in agreed upon dates and times: 4: Date _________Day________ Time __________
1: Date _______ Day _______ Time___________ 5: Date _________Day________ Time __________
of week of week
2: Date _______Day________ Time___________ 6: Date _________Day________ Time __________
of week of week
3: Date _______Day________ Time___________ 7: Date __________Day________ Time __________
of week of week
General Information: (please pay attention to #5 and #6 )
1. Students eighteen years of age and under are required by the State of Virginia to complete a state approved
driver’s education program. The requirements for Behind the Wheel are fourteen fifty-minute periods of
which seven periods are spent driving and seven periods are spent observing.
2. Payment is due upon registration and there is a $25.00 fee for returned checks.
3. A full or partial refund, depending on the number of hours completed, will be made upon request only if
this school is incapable of or unwilling to perform its part of this agreement within one hundred twenty
days of registration.
4. The instruction provided by this school does not guarantee that any student will pass the state license
examination or that the student can secure a driver’s license or the student will be guaranteed employment
upon completion of course.
5. In the event a student misses a scheduled behind the wheel lesson without twenty four hour notice,
there will be a fee of $30.00 for missed weekday appointment and $40.00 for weekend appointment.
6. Instructors will make it clear to the parents if we feel the student needs more practice and is not
ready for the driving test after the lessons. If the parent disagrees and wants us to administer test
and the student fails, there will be a $50.00 charge for further tests.
7. If a student wants more than the 14 periods provided, the fee will be $50.00 per fifty minutes.
8. Student has permission from parents if under eighteen or gives permission if he/she is older then 18, to
receive one to one training with the instructor. The student is required to meet the observation
requirements with at least one other student in the vehicle during in-car vehicle training.
9. DMV is committed to providing transportation safety through the certification of quality driver
training programs. If you have comments or concerns about this course, call their toll-free number
I have read and understand the information provided in this contract. Parent signature is required for students
under the age of eighteen years old.
Parent Signature_____________________________________________ Date _________________
Instructor Signature ________________________________________ Date _________________
Student Signature (only if 18) __________________________________ Date ________________ (Rev 4/11)