TRI-COUNTY STUDENT DRIVING SCHOOL, LLC License # 1478 BEHIND-THE-WHEEL TRAINING AGREEMENT (application) (for students who enrolled in an online driver training course)

Student’s legal name: ______DOB: ____ / ____ / ______Student’s address: ______Street City / Town Zip Code Student’s cell phone # ______High School attending: ______Student’s permit # ______Issue date: ____ / ____ / ____ First permit? ______

Tri-County Student Driving School, LLC, hereinafter referred to as “Tri-County” agrees to provide the applicant, hereinafter referred to as “The Student”, at least 8 hours of behind-the-wheel (BTW) training based on the Ohio Driver Training Curriculum. If The Student has not completed the online training, submit the original “Certificate of Enrollment” with this application. If The Student has completed the online training, submit the original “Certificate of Completion” with this agreement. Tri-County will furnish a state certified licensed instructor and a state approved motor vehicle for the BTW training. Upon successful completion of all training, Tri- County will furnish a “Certificate of Completion” to The Student.

Fees: Tuition for the eight hours of BTW instruction - $300 (to be submitted with this application). (tuition fees include $10 filing fee, $36.25 / hr. for operating cost of company vehicle and instructor’s fee) Additional BTW training upon request - $35 an hour. Use the Driving School’s vehicle to take a driving exam at State exam center - $50. The Student was not available or prepared for the BTW training - $25. Proper cancellation notice not given - by 9am on the day scheduled to drive if on a school day or by 8pm on the day prior if scheduled to drive on a non-school day (unless due to illness) - $25. Return check fee / insufficient funds - $25. Replacement of lost certificate - $10. Filing fee to extend training (mitigating circumstances as mentioned in section below) - $10.

Prior to the start of the BTW training, The Student is required to obtain a temporary driving permit. Under Ohio rules (4501-7-09(A) (8), the BTW training must be completed no less than six months from the first day of training unless mitigating circumstances on behalf of The Student (health and family issues that disrupt the student's ability to receive training). If The Student is unable to complete the BTW training within the six months due to such circumstances and wishes to complete the training, written documentation of the mitigating circumstances must be submitted to Tri-County along with the fee. Tri-County must submit this documentation to the state and be approved before any training can continue. If the state does not approve the mitigating circumstances as a valid reason for not completing the training with the six months of this agreement, any previous training is voided. If training is not completed, refund of tuition cost (minus filing fees) will be pro-rated based upon hours of service provided by Tri- County. If a new agreement is required to be completed, all fees will be applicable under the new agreement.

Tri-County does not guarantee the issuance of a driver license to The Student after completion of the BTW training. The Student must successfully complete the state driving test in order to obtain a state issued driver’s license.

Commercial driving schools are licensed by the Department of Public Safety through the Driver Training Program Office, 1970 W. Broad St., Columbus, Ohio 43223. Valuable information for parents and teenagers is available on the internet at www.drivertraining.ohio.gov, under Parents and Teens.

DOWNLOAD MEDICAL FORM – PRINT ON REAR OF THIS AGREEMENT and complete.

Your signature below attests to the fact that you have read, understand, and agree to the terms of this agreement. Both Student and Parent must sign.

Student ______Date _____/_____/______

Parent/Guardian ______Date _____/_____/______

Tri-County Official ______Date _____/_____/______

Return this form to: Trena Bartz * 220 Keplar * Van Wert, Ohio 45891

*Include check payable to Tri-County Student Driving School (payment plans available upon approval – (419-513-1146) *Include “Certificate of Enrollment” or “Certificate of Completion” (whichever is applicable)