Packages (COVID)

Name of person taking lesson*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

Confirmation Email

Is this for a Gift Certificate*

yesno

Who would you like to say the gift certificate is from?

Email address for the gift certificate to be sent to

Email

I am available

AnytimeWeekends onlyEvenings only (after 3:00 pm)

Is there anything that you would like us to know before we contact you to schedule lessons?

Packages*

Gold Package 60 Minutes (10 Lessons & 5 Hour Course)$750.00

Silver Package 60 Minutes (6 Lessons)$455.00

Bronze 60 Minutes$230.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

The safety of our students and instructors at Bell’s Auto Driving School, Inc. has always been our highest priority. Our current COVID policy is as follows:

All students and instructors will be required to wear masks at all times while in the car. Instructors will continue to clean and sanitize our vehicles in between each lesson in accordance with CDC guidelines.

Our 24-hour cancellation policy will remain in force. If 24 hour notice for any cancellations is not provided you will be subject to the $25 cancellation fee.

If you have any questions regarding the policy/procedures listed in this acknowledgement, you should contact us as soon as possible to allow us to address your concerns.

I understand the above cancellation policy and I (or minor child) agree to wear a mask at all times in the car. *

Signature

Name of Person Signing*

First NameLast Name

I agree that I am over the age of 18 and/or the parent or legal guardian of the above mentioned student*

yes

Date

Comments

COVID Awareness Agreement