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Pre-Registration

(To be completed by a parent). You should have already selected which venue you wish to attend, and become familiar with the pricing at that venue. (If you need to obtain a schedule or pricing information, simply click here: https://www.accidentavoidanceworkshops.org/dates.html, and one will be sent to you immediately.)

Your student needs basic control of their vehicle prior to enrolling them. If you’re afraid they’ll get out of the car without putting it in park first, or mixing up the brake and accelerator pedals, we encourage further development prior to enrolling. The consequences of driver error always need to be considered.

Once you have decided on a date and location, complete the entire pre-registration which follows. You may complete it all now, or just do the first part now and the “Critical Information” later, when you have more time to do so. But to reserve a space, all sections needs to be completed thoughtfully.

An e-mail acknowledgement typically follows within a few days after you have completed all sections. This e-mail will provide you with everything you need to know to prepare for the Accident Avoidance Workshops.
 
 

For which event would you like to register?

Venue/Location: A value is required.   

Classroom Date (All will attend this classroom session, so record it in your calendar right now!):
A value is required.

On the weekend following the classroom session, which driving session listed on the schedule is most convenient for you?(We always do our best to give you your preferred session, and in the order you indicate. If you only indicate availability for say, one of the driving sessions, and it is already sold out, we will put you on the waiting list for that driving session and only send your confirmation if someone cancels or withdraws and we can place you in that space.)




Please make a selection.

And, for how many of the other driving sessions could you make yourself available that weekend if your first choice is sold out?




The Venue name and dates WILL NOT be included in your confirmation e-mail. If YOU selected them, you can certainly remember them. Record them in your calendar NOW!

Student's given name:  First: A value is required.   Last: A value is required.

Name student goes by (nickname): A value is required.

A value is required.

Which high school, college, or homeschool group does your student attend?
A value is required.

Student's date of birth (MM/DD/YY): A value is required.Invalid format.

Does your student have their permit or license?


Please make a selection.

Parent #1: (Co-attending adult must be parent, and/or legal guardian of student(s))
A value is required. A value is required.

Parent #2 if attending either classroom or driving session:


Street address to which the credit card is billed:
A value is required.

City: A value is required.   State: A value is required.   Zip: A value is required.Invalid format.

Parent or legal guardian e-mail address: A value is required.Invalid format.
(Notice: All further correspondence will be sent to whoever’s e-mail address you provide here. Be sure it’s input correctly, and you have Homer@AccidentAvoidanceWorkshops.org set up as a “safe sender” on that computer. The program materials you will be sent will come in the form of embedded links and/or attachments, and if your computer blocks them, it will deprive you of the ability to complete this program.)

Phone Primary (XXX-XXX-XXXX): A value is required.   

Phone Secondary (XXX-XXX-XXXX): A value is required.

  
We prefer no Capital One cards, please.
No surcharges for personal debit/credit cards. 5% surcharge for business, commercial or corporate cards.


Credit Card Number: A value is required.Invalid format.   Expiration Date (MM/YY): A value is required.
If your credit card expires prior to two weeks prior to the weekend you chose, your credit card will be declined when we process it.
If your credit card is cancelled prior to two weeks prior to the weekend you chose, your credit card will also be declined when we process it.
A declined card can cancel withdraw your registration and withdraw you from the event.


3 Digit CID Number (4 Digit for American Express): A value is required.Invalid format.Exceeded maximum number of characters.

Name as it reads on credit card: A value is required.

How did you hear about the Workshops? A value is required.



Critical Information!

Your pre-registration is not complete, and you cannot be put on the roster until you answered all the questions in this “Critical Information” section..
You can complete it now … or if you don’t have the time necessary to do it justice now, we can arrange to make it easy for you to do later.
EVEN IF YOU’RE REGISTERING LONG IN ADVANCE, do it now so a spaces gets reserved for you. You can always come back and update it later
  1~ To complete it now … simply continue, and click the “Submit” button when you’re done.
  2~ To complete it later, scroll down and click the “Submit button now. Soon thereafter, we will send you a link you can use to go back and complete your reservation without having to re-do what you have just completed.

Once completed, a confirmation/communication will follow.

    
The following questions will determine how effective you can expect this training to be. We pride our program in being the most personal program available in the U.S. And you’re about to find out why. This is where you help us understand your student’s learning style so we can connect with your student on a level other programs cannot. Please share with us anything you feel may help us connect with your student and help them learn. Even things you may not suspect to be beneficial can help us: an accomplishment of which they’re proud, an embarrassing moment at which they can laugh, or even something personal about them of which you’re very proud. And the more weird, more embarrassing, of funnier, the better! You can avoid the typical “great kid” stuff we get from everyone … but better yet, here are some good examples from the past:, “Ran in to their Principal’s car at school”, “Loves to have his head scratched”, “Can imitate every Disney character”, “Got his head stuck in a shop-vac when he was 13”, “Falls down the stairs often”, “Has a cat named ‘Death from above’”, “Eagle Scout or Star Award” etc. DO NOT make the mistake of dismissing this as insignificant … it’s the single-most important information you will provide. Now … let’s have it!:

Describe in detail any crashes or traumatic experiences your student has had while driving.


Has your student received any citations to date? If so, please provide details.


How’s their driving so far? And more importantly, WHY do you say so?


Describe any weakness(es) you would like us to address and/or reinforce for you in class.


Skipping this questions is not an option. This one is delicate, but critical enough that we insist you level with us here, as safety is paramount in the Workshops. Please describe any physical or emotional restrictions or limitations your student may have, including but not limited to anything for which they are on medication. If your student HAS such concerns, please understand we can accommodate most of them. The reality is, if you feel they are capable of driving, we will likely feel some sort of accommodation can be made to have them attend the Workshops. But misrepresenting your student’s abilities can be grounds for immediate dismissal from the program with no eligibility for refund. So be candid in your reply to this one with full confidence in our discretion. So again … please describe any physical or emotional restrictions or limitations may have that we need to know about:


Do they suffer from Deuteranopia, or any form of color blindness, and if so, which colors do they have difficulty distinguishing?


And please let us know for which, if any of these they take medication.
A value is required.

In what sports or extracurricular activities do they participate?


What musical instruments do they play, if any?


Do they have siblings and if so, where do they rank sequentially? (ex: Middle child of 3, only child, oldest of 4, etc.)


What subjects in school do they ENJOY the most? (Not necessarily that they EXCEL in … but ENJOY the most…)


Now the fun part: Give us some dirt on your kid! Tell us something funny, or better yet, embarrassing about your student! Of course, we use discretion, so no “Oh, they would kill me” replies will fly … just help us with anything that will help us connect with them and relate with them better!)


Tell us about one of your students unusual accomplishments that is outstanding, impressive, admirable. (We already know your child is the straight-A, AP class, mission-trip going, kindest kid on the planet and everyone likes them. So now, rethink your answer to this question before you respond!).


Are they overly-sensitive about anything (i.e. being a nerd, being short or having Acne) or overly-enthusiastic about anything (i.e. Minnesota Vikings fan, New York Yankees fan, UGA fan)?


Please understand … we treat all of this information with discretion. And again … your candor helps us to that end. What, (if anything specific), are your biggest areas of concern(s) with respect to your student starting to drive? (For example, what’s the biggest WEAKNESS your student is facing that you feel needs improvement? Or, what have you been trying to drive home with your student you think they may be more likely to listen to if it comes from us? For example, there’s no need to say “drives too fast”, or “follows too close”, or “emphasize no cell-phone”, or “drives with one hand on the wheel”, because they’re already a BIG part of the program, but is there any one “goofy” little thing you’d like to make sure gets addressed you feel could significantly help your student?


Terms and Conditions:
Once you complete the ENTIRE pre-registration, you will then receive confirmation of the driving session in which you were placed. Be sure your computer is set up to receive e-mails from Homer@AccidentAvoidanceWorkshops.org. All future communications, which make up about 60% of the program, will come from this address. You will be required to sign a waiver/release in order to participate in both the classroom session and the driving session.

Your financial commitment:
Up until the billing date (2 weeks prior to the classroom session, or immediately if that window has already passed), you may cancel, withdraw or transfer/reschedule by e-mail only. You attendance is committed after that, no exceptions. Base tuition includes both parents for the classroom. $40 in cash paid on the driving day will admit a second parent. Only those who complete the entire program will be entitled to the benefits for doing so.

Please make a selection.

To submit, click the button below.
~ If your submission succeeds, the next screen you see will read, ”Thank you for your PRE-Registration!”
~ If it does not, something is incomplete. Scroll up and complete any sections showing as incomplete, and re-try.