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Mail to: 3113 So. Ridgewood Ave. Edgewater, FL 32141 Tel: 386-427-8522 Fax: 386-427-3915

Last Name First Name Initial
Street Address
State Zip Code  
Home Phone # Work Phone #
E-mail Address Class Date Requesting
Personal Information
Birthdate (ALL minors must be pre-approved) Height (5'4" or less provide "heel-to-wall")
Weight (for safety reasons restrictions may apply) How did you hear about us?
Do you possess a valid driver's license?  q YES  q NO     DLN #
Do you have any handicaps or health problems such as color blindness, heart condition, high blood pressure, etc.., which might endanger your life or others while taking this course?  If yes, explain:
What safety equipment will you bring?
Head Restraint System  q Firesuit  q Helmet  q Nomex Underwear   q Gloves
Type of race car you prefer (car/truck type subject to availability)
Modified  q Late Model  q Truck
Can you use a manual shift?  q Yes q No
Class Selection
q Take A Ride On The Wild Side (5 Laps) q Race to Win/Advanced Course (3 Days)
q Feel The Thunder q Driver Development Program (2 Days)
q Intro. To Short Track Racing (1 Day) q Mechanics/Chassis Seminar (1 Day)
q Competition Driving Course (2 Days) q Private Lesson
Disclaimer / Signature / Payment Information
Deposits are required no later than one month before scheduled class to guarantee you a seat in the race class.
I understand that my deposit, less a $50 registration fee, and a 3% processing fee will be returned if I cancel the course for which I am scheduled at least 21 days in advance. If I cancel less than 21 days prior to the course, my deposit will not be refunded. I will be assessed a 25% late cancellation penalty but can apply the remaining 75% to a course at a later date. A date change fewer than 21 days prior to the start of my course is considered a cancellation and will be treated accordingly. I also understand that if I cancel less than seven days prior to the course, or fail to attend without notifying Finish Line Racing School, I will lose my entire deposit. I further understand that if I use the race cars and school equipment in a reckless, abusive, grossly negligent or wanton manner, that I will be directly liable for all bodily or personal injuries sustained by any person and; any and all damages to equipment. Any damages that result from a mechanical failure is the responsibility of the school.
Date: Applicant Signature
q Check or Money Order Enclosed   OR  q VISA q MASTERCARD q AMERICAN EXPRESS
Amount:  Card Holders Name (please print clearly)
Expiration Date: Card Holders Signature:
*Tuition balance MUST be paid in either CASH or a CASHIER'S CHECK or C/C (a 3% processing fee applies to ALL credit card payments). . Personal checks will NOT be accepted.