Both the APPLICATION & CONTRACT must be COMPLETED & SUBMITTED! APPLICATION STUDENT FIRST AND MIDDLE NAME * Please include first and middle name in box below First Name Last Name STUDENT EMAIL PARENT'S NAME First Name Last Name PARENT'S EMAIL ENROLLMENT DATE MM DD YYYY ADDRESS CITY STATE ZIP CODE PHONE (###) ### #### ALTERNATE PHONE # (###) ### #### DATE OF BIRTH * Must be at least 15 to sign up MM DD YYYY SCHOOL ATTENDING SPECIAL NEEDS MEDIA RELEASE SIGNED BY STUDENT & PARENT YES NO Checkbox I agree to the following Terms and Conditions I understand that students seeking Indiana driving privileges must be enrolled at a driver training school licensed by the Indiana Bureau of Motor Vehicles and must be at least 15 years of age to earn credit for completing online driver training. I am a legal adult registering an account for myself, or I am the parent and/or guardian of the individual for whom this account is being created, and as such, I approve of their involvement in this course. Parent Signature First Name Last Name Thank you! Click this button to print the current page. Print this page CONTRACT This contract is made and entered into by and between Blue River Services Driver’s Training hereinafter called school and Student's Name: First Name Last Name ... here in after called “the student” for a course in driver education. The School agrees to provide the following: 30 hours of driver education theory done online through an approved BMV online training school and 6 hours of behind-the-wheel instruction through Blue River Services Driver’s Training. A copy of the final grade also is required, which should be printed from the final page of the online course and emailed to driversed@brsinc.org faxed to 812-738-8846. The student will be scheduled by Blue River Services Driver’s Training for six of behind-the-wheel instruction once the online session is completed. The fee for the course is $405. It is payable in advance and is due when this contract is signed and returned. In the event the student fails to complete the online course within six months of being issued online access to the training courses, the student/parent/guardian total amount of the fee paid will be forfeited. The school and the student agree to the following terms and conditions: 1. Behind-the-wheel instruction is conducted by appointment only. The student/parent will be charged $35 dollars for any appointments he/she does not meet, unless the school is given at least 24 hours’ notice. BRS does understand that unexpected events can occur; therefore, those circumstances will be considered on a case-by-case basis. 2. Behind-the-wheel instruction is performed on a first-come, first-served basis. Students will be scheduled upon proof of completion. Students are not scheduled in the order of the date the student enrolled in the Driver’s Training Course. 3. Certification for completion will be issued once all sessions of the program have been completed. 4. The school will complete the course in a reasonable length of time. However, it cannot be held responsible for delays caused by mechanical failure, unsafe driving conditions due to bad weather, or any other reason over which it has no control. The school will give the student as much notice as possible if any delay becomes necessary. 5. The student understands that certain hazards and risks are inherent in the operation of motor vehicles, the student does hereby specifically assume all such risks as may be incurred in the normal operation of a motor vehicle during the course of instruction. Each vehicle is fully insured with liability coverage in the amount of one million dollars. The student does hereby fully and completely release the school, its agents and employees, from any liability whatsoever, and from any and all claims or causes of action resulting or arising from any damage or injuries suffered by the student during this course or any extension thereof, to the extent that such claims shall not be covered by school's insurance coverage. The student does hereby further agree to indemnify and hold the school harmless from any claim made against it for any damage or injury suffered by any person, company, corporation, or other entity, as a result of the student's operation of a school vehicle, or as a result of the student's course of instruction, to the extent that such a claim isn't covered by the school's insurance coverage. 6. The fees set herein are guaranteed for 180 days from the date of this contract. 7. The school cannot guarantee that the student will successfully pass the examinations given by the Bureau of Motor Vehicles upon completion of the course. The school does agree to exert its best efforts in teaching the student to meet the requirements of the examinations. 8. If ADDITIONAL instruction of services is needed AFTER the conclusion of the program; please call 812-738-3198 Monday – Friday 8 a.m. - 4 p.m. This contract constitutes the entire agreement between the school and the student and no verbal representations, assurances, or promises not contained here in shall bind the school or the student. * Student's Name: First Name Last Name This contract constitutes the entire agreement between the school and the student and no verbal representations, assurances, or promises not contained herein shall bind the school or the student. Parent & Guardians Name: First Name Last Name Date MM DD YYYY Thank you! Click this button to print the current page. Print this page
