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Segment 1
drivers training
Complete the online registration form below or download the PDF version to mail or drop off at our office
Segment 1 Contract
Name (Include Full Middle Name)
*
First
Middle
Last
Address
*
Street Address
City
ZIP Code
Phone
*
Age
*
Please enter a number from
14
to
50
.
Date of Birth
*
MM slash DD slash YYYY
Parent/Guardian Name
*
First
Last
Parent/Guardian Phone
*
Address
*
Street Address
City
ZIP Code
Email
*
Class Begin Date
MM slash DD slash YYYY
Please let us know the date for the first day of class so we can be sure to enroll you in the proper class
TEEN SEGMENT 1 PROVISIONS
ABC Training & Testing will provide a minimum of 24 hours of classroom instruction, 6 hours of behind the wheel (BTW) instruction and 4 hours of observation time with a certified Michigan Driver Education Instructor
Classroom instruction must be a minimum of 3 weeks in length and shall not exceed 2 hours per day. BTW instruction shall not begin until the student has received a minimum of 4 hours of classroom instruction and must be completed no later than 3 weeks after the classroom instruction has been completed
ABC Training and Testing will conduct the BTW instruction in a dual-controlled automobile that is insured by the Provider to cover each student enrolled in the program
The Student must be at least 14-years and 8-months of age by the first day of a Segment 1 course. Verification by birth certificate is required
TEEN SEGMENT 1 TERMS
The Parent or Legal Guardian agrees to pay the total amount of $345 on or before the first day of class in the form of cash, check, or credit card. Online registration requires payment immediately.
The Student and at least one parent or legal guardian must attend the Parent Meeting
The Student may miss class only for an illness or emergency with documented appointment cancellation
A fee of $20.00 will be charged if 24 hours advance notice is not given for a driving appointment cancellation
A fee of $20.00 will be charged for each lost or damaged textbook or workbook
A fee of $10.00 will be charged for each request for a replacement of a Segment One Completion Certificate
REQUIREMENTS TO PASS THE COURSE
The student must complete all homework and receive an overall grade of 75% on daily quizzes/test
The student will be allowed up to three attempts to pass the State Exam, which requires a score at least 70%
The student must pass ALL BTW Performance Objectives, per the Driver Education Provider and Instructor Act (DEPIA) at the instructors professional discretion with a satisfactory or higher grade
REFUND POLICY
ALL fees are non-refundable
BTW WAIVER
Section 33 (d) of the Driver Education Provider and Instructor Act requires that at least two students must be in a vehicle during BTW instruction unless a parent waives this requirement in writing
I, the Parent/Guardian of the Student, waive this requirement
*
I, the Parent/Guardian of the Student, waive this requirement
I understand that my son/daughter must still complete at least 4 hours of observation time as a passenger in a driver education vehicle being driven by another driver education student
Date
*
MM slash DD slash YYYY
Student E-Signature
*
Date
*
MM slash DD slash YYYY
Parent/Guardian E-Signature
*
Date
*
MM slash DD slash YYYY
ABC Training and Testing By:
ACCOMMODATIONS/MEDICAL CONDITIONS
Does the student require any special accommodations to participate in the classroom phase (e.g. test being read, interpreter, etc.)?
*
Yes
No
If yes, please explain
Does the student require any special accommodations to participate in the BTW phase (e.g. adaptive devices, interpreter, etc.)?
*
Yes
No
If yes, please explain
Are there any medical conditions that would pose a concern with the Students BTW instruction (e.g. epilepsy, color blindness, etc.)?
*
Yes
No
If yes, please explain
*
Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely?
*
Yes
No
If yes, please explain
*
Is the student's visual acuity at least 20/40 corrected?
*
Yes
No
In the last 6 months has the student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness?
*
Yes
No
If the answer to any of questions 5-7 is Yes, then the parent/guardian must provide a letter signed by the students physician indicating that the condition has been corrected and/or is under control and the students meets the physical and mental requirements for a motor vehicle operators license under Section 309 of the Michigan Vehicle Code, 1949 PA 300, MCL 257.309
Date
*
MM slash DD slash YYYY
Student Signature
*
Date
*
MM slash DD slash YYYY
Parent/Guardian Signature
*
Date
*
MM slash DD slash YYYY
ABC Training and Testing By
VISUAL SCREENING TEST
FOR OFFICE USE ONLY
I,
have been administered a vision screening test on,
by,
and received a visual acuity score of at least 20/40 corrected.
Payment Amount:
Date(s):
Type:
PARENT DRIVING PERMIT AUTHORIZATION
After 10 hours of classroom and 2 hours of BTW instruction, students may be issued a pink learners permit. This permit allows a student to operate a motor vehicle on public roads while under the supervision of parent or legal guardian. The purpose of this permit is to provide an opportunity for reinforcement of the instruction already received. This permit expires after completion of the students segment 1 driver education program.
Student Please Enter Name
*
I authorize the issuance of the pink permit to my student:
First
Last
Parent E-Signature
*
DRIVING SCHEDULING SHEET
Students Name
*
First
Last
Student Phone
*
Parent/Guardian Phone
*
Email
*
School Attending
*
School Dismissal Time
*
:
Hours
Minutes
AM
PM
Days and times student CANNOT drive:
This would include any sports/after school activities, doctor appointments, or any other event that would conflict with your availability to drive on a particular day.
I would like my driving partner to be:
Check-Out
Segment 1 Registration Fee
*
Price:
You will be directed to Paypal to make your full payment. Online registration is not complete without payment.
Total
$0.00
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