Defensive Driving Course Enrollment
1. Complete and submit this form. 

2. Submit payment. Once payment has been received, a receipt will be issued and included in your file for all payments, including any CashApp, Venmo, or Credit Union Deposit transactions.  

Enrollment cannot be finalized until payment is received AND this form is submitted.
  
Due Prior to the Start of Class (non-refundable)
  • Course Enrollment                   $125.00
A credit card convenience fee of 2.99% will be applied to all transactions. This fee is charged to cover the processing costs associated with credit card payments. Please note that this fee does not apply to other payment forms such as cash or checks. 

Returned checks due to insufficient funds will incur a $30.00 NSF fee.  

If you would like faster service or direct information please contact us at (423) 922-8727 or jubilee@steercleardriversed.com 
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Email *
Steer Clear Driver's Ed, LLC
Jubilee Lawhead, Owner
304 Cherokee St. Kingsport, TN 37660
(423) 922-8727
www.steercleardriversed.com
Student Name (Last, First) *
Student's Permit/License No. (if none enter Date of Birth) *
Student's Phone *
Student's Full Address *
Emergency Contact Name and Phone *
Student Medical Conditions or Allergies *
Please use this space to share necessary relevant information. 
Course Selection  *
Payment Method Selection *

Contract, TN Regulation, and Eligibility Acknowledgement

I acknowledge that this contract constitutes the entire agreement between Steer Clear Driver's Ed, LLC and the student, and no verbal statements or promises will be recognized.

I acknowledge that Tennessee State regulations are available for review in the classroom.

Successful completion of this Driver Improvement Course cannot guarantee eligibility for a license or points reduction.

 *
Required

Attendance Acknowledgement

I acknowledge that in-person or online attendance is required for the duration of the 8-hour course as well as a passing grade on the final exam in order to receive a Certificate of Completion. 

Should a student fail to attend any portion of the required time, Steer Clear cannot issue a certificate to the student or court. Additionally, no refund will be given (full or partial), and the student will be required to retake the entire course at a later date. 

If attending via Zoom, I understand that a working mic and camera are required for the entire course. Certificate will not be issued without camera use.

*
Required

Alcohol & Drug Policy 

I agree to Steer Clear Driver's Ed Zero Tolerance Alcohol & Drug Policy. In the event we have reasonable suspicion that you are under the influence of alcohol or drugs, you will be dismissed from the course, and no refund (full or partial) will be given.

 *
Required

Disclaimer

Participation in the Defensive Driving Course does not grant driving privileges or serve as a substitute for a valid driver's license. It is the sole responsibility of the participant to ensure they hold a current and valid driver’s license. Steer Clear Driver’s Ed and its instructors are not liable for any legal consequences, citations, or incidents resulting from a participant operating a vehicle without proper licensure.

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I acknowledge that clicking "Submit" at the end of this form serves as my electronic signature and will be time and date stamped.  *
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A copy of your responses will be emailed to the address you provided.
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