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Pre-Registration

(To be completed by a parent)

Terms and Conditions:

READ THIS PRIOR TO REGISTERING: ~ You may cancel your registration anytime within 24 hours of submitting it, and must request cancellation by e-mail only for documentation purposes. No sooner than that point in time, billing will take place and we will purchase all of the insurance, materials and resources, as well as make all of the commitments necessary to accommodate your family based on your request to attend. Once that investment is made, we are unable to accommodate reschedules, transfers, or refunds for any “conflicts” of any kind. If there is any doubt you can’t commit to attend, do not register until your promise can be kept.

~ Should a medical or family emergency arise any time prior to the classroom session, you may still gift/sell your admission to someone else as opposed to having to forfeit your space, as is the case with any other mass audience service, (concert, ball game, etc.), however the event will take place as scheduled, with room for you to join us at your request.

~ Within 7 days, you will receive either a confirmation of an available timeslot for which you indicated availability, or a sold out notification with a current schedule from which you may choose to select another venue. All future communications will come from the following address: Homer@AccidentAvoidanceWorkshops.org. So be absolutely certain your computer is set up to receive e-mails from that address.

 
 

Please make a selection.
Please make a selection.
Please make a selection.
Please make a selection.



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 your “back” button or go to the homepage, and click the yellow button instead of the green one.)

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?





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:
(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.)
A value is required.Invalid format.


Phone (Primary) hyphens only, please i.e.: 612-555-4937: A value is required.   

Phone (Secondary) hyphens only, please i.e.: 612-555-4937: 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 is declined, you will be notified and given 48 hours to rectify the situation before your registration is withdrawn 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!

Incomplete pre-registrations cannot reserve a spot, so be sure to complete the “Critical Information” thoroughly:.
We pride our program in being the most personal program available in the U.S. And you’re about to find out why. This section helps 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 are very proud. And the more unusual, the more embarrassing, or the 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 … to an educator, it’s the single-most important information you will provide.
(If you choose to submit your registration incomplete, it will remain in our “on-hold” file until you return to https://www.AccidentAvoidanceWorkshops.org/criticalinformation.html to complete it.)

Has your student had any accidents, and if so, please elaborate on the nature and cause of the crash.


Has your student had any other traumatic experiences while driving? (Describe).


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?


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


Does your student have any physical or emotional restrictions or limitations, including by not limited to, anything for which they have been treated clinically? If your student has such issues, please understand we can accommodate the majority of them, however, misrepresenting your student’s abilities can be grounds for dismissal from the program with no eligibility for refund, so be candid in your reply with full confidence in our discretion.
A value is required.

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

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


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, and therefore help them enjoy it more!)


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)?


Complete the following sentence: “If my kid could just learn ONE THING from this program, I hope that one thing is … “
(Hint: Looking for an answer OTHER THAN “Drives too fast”, “follows too close”, “hugs the line”, “no cell-phone”, or “drives with one hand”, … they’re already a BIG part of the program.)




To submit, click the button below.
~ If submitted complete, the next screen will read, ”Thank you for your PRE-Registration"
~ If not, scroll up and complete any sections showing as incomplete, and try again.