Road to Success Online Classwork

For more information or questions, please contact:

740.283.3347

roadtosuccess@jcesc.org
Road to Success

ONLINE DRIVER EDUCATION

TRAINING AGREEMENT
Road to Success Driving School, a licensed online driver education provider, offers students access to the required online driver education theory course for a fee of $60.00.

Students are responsible for completing the online coursework through the access provided by Road to Success Driving School. The online course must be completed within 180 days of enrollment. Students who fail to complete the course within this timeframe will be required to retake the course.

Upon successful completion of the online coursework and submission of a copy of the student's valid driving permit, a Certificate of Completion will be issued. Students must provide this certificate to Road to Success Driving School before beginning the behind-the-wheel portion of their driver education training.

Please Note: Completion of the online theory course and submission of the required documentation are prerequisites for scheduling behind-the-wheel instruction.

Student Acknowledgment and Agreement

By signing below, I acknowledge that I have read, understand, and agree to the terms and requirements outlined above, including the $60.00 course fee, the 180-day completion deadline, and the requirements for receiving my Certificate of Completion and beginning behind-the-wheel instruction.
Student Name:

First NameMiddle NameLast Name
The course to be delivered to this email address:
example@example.com
**This course will be delivered to the email listed above within 48 hours of registration.**
Phone Number (Student Cell):
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Parent Cell):
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Home):
Please enter a valid phone number.Format: (000) 000-0000.
Student Printed Name:
Student Signature:
Date Signed:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Parent/Guardian Printed Name (if student is under 18):
Parent/Guardian Signature (if student is under 18):
Date Signed:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Programs and fees:

24-hour online drivers training course

$60.00

Total

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

Email address to receive invoice:
example@example.com
**Once payment has been received, a receipt will be sent to the email provided in this registration.
Should be Empty:

Programs and fees:*

Programs and fees: