American Driving Academy Inc.
Home Study Course Application

Name of Student_____________________________________________________
Birthdate________________________ Age_______________________________
Address___________________________________________________________
__________________________________________________________________
Home phone#____________________Other#_____________________________
Name of Parent or Guardian____________________________________________

Check which program you would like:

___1. Home study classroom instruction plus six hours of driving instruction with an instructor from American Driving Academy -- Now available in Colorado only. Coming soon to your state. (Teens age 15 can get permit with this program).

___2. Home study classroom and home study driving instruction. (Available in all  states) $135.  (Teens age 15 years and 6 months can get permit with this program).

*Students registered in either program are welcome to attend any classroom sessions at any time to take the permit test, get additional help on their work, or to just be involved with the lessons for the day. -- Available in Colorado only. Coming soon to your state.

Check how you are paying:
___1. Check/Money order
___2. Credit Card
Type of Credit Card_____________________
Card Number__________________________
Expiration Date_________________________
Address of Card Holder__________________
____________________________________

Please mail or fax completed form to:

American Driving Academy Inc.
1715 Monterey Road Suite #150
Colorado Springs, CO
80910

Fax: 719-633-2488

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