In-Person Classroom Only Signup Form Student Information First Name Middle Initial Last Name Street Address City Zip Code Phone Number Date of Birth Parent Information First Name Last Name Phone Number Email Sessions & Payments: 30 Hours of Classroom $100.00 Please Select Location and Time: Viroqua HS: October 2, 9, 16, 23, 24, 28, 30, 31 and November 4, 6, 7, 11, 12, 13, 18. Class will meet from 6:00 p.m.- 8:00 p.m. Please Select Your Method Of Payment: PayPal PaymentPersonal Check payable to Street Smarts Agreement Students are not responsible for damages to the vehicle. If a student fails to show up for a scheduled driving lesson or cancels within 18 hours of the scheduled lesson the instructor may assess a $20 charge. There will be a NSF fee of $25.00 for all returned checks. This constitutes the entire agreement between Street Smarts Driving School LLC and the customer or student and no verbal statement or promises will be recognized. When you press Submit you will be taken to Paypal to pay for the class. If you choose to pay by check please mail to: Street Smarts Driving 119 West Court St. Viroqua, WI 54665 You will receive an email confirming your registration.