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Segment 2
drivers training
Complete the registration form below or download the PDF version to mail or drop off at our office
Segment 2 Contract
TEEN DRIVER EDUCATION SEGMENT 2 CONTRACT
NOTICE: This provider is required to be certified by the Secretary of State. If you have any complaint, which you cannot settle with this school, please complete the Driver Education Complaint form found on the Department of State website; www.michigan.gov/teendriver. Completion of driver education instruction does not guarantee qualification for a driver license.
Student Name
*
First
Middle
Last
Address
*
Street Address
City
ZIP Code
Phone
*
Alternate Phone
Email
*
Date of Birth
*
MM slash DD slash YYYY
Age
*
Parent/Guardian Name
*
First
Last
Phone
*
Alternate Phone
Address
*
Street Address
City
ZIP Code
Program #
Please list the Program #, if known.
Date
MM slash DD slash YYYY
Classroom Location
*
Dates of class
MM slash DD slash YYYY
For the purpose of providing segment 2 driver education, ABC Training and Testing will charge a fee of $50.00 payable prior to the start of the class and is non-refundable. Tuition may be paid via cash, money order, check, Visa, or MasterCard.
We will need the following documents/information the first day of class
Student and Parent/Guardian need to complete and sign the enrollment forms
Level 1 learners permit
For a student to participate in Segment 2, verification must be received that they student has completed a minimum of 30 hours of driving (including 2 hours at night) with a licensed parent/guardian (or parent designee) on a level 1 license, which has been held for not less than 3 continuous months
Driving Log
Level 1 Permit Issue Date
*
MM slash DD slash YYYY
Drivers License Number
*
TEEN DRIVER EDUCATION SEGMENT 2 CONTRACT - REQUIREMENTS FOR ADMISSION AND SUCCESSFUL COMPLETION
For student to participate in segment 2, verification must be received that the student has completed 30 hours of logged driving time (including 2 hours of night time driving) with a licensed parent or guardian (or parent designee) on level 1 license, which has been held for not less than 3 continuous months
Absences are not allowed. Student must attend 6 hours of classroom instruction. Classroom instruction shall not exceed 2 hours per day
Student must attain an 80% or better average for classroom assignments. Missing and/or incomplete assignments will result in automatic failure of class. Students must participate in class discussions, activities, and complete all work on time
Student must score 70% or better on the Secretary of State mandatory written test. Student who fail this test three times will be required to retake Segment 2
Sleeping in class will result in automatic failure of class
Students must maintain proper classroom behavior, with respect for instructors, school officials and school property, before, during and after class. Disruptive behavior will result in failure of class
There will be a $10.00 fee to replace segment certificates
NOTICE: Completion of this course does not guarantee that student will pass the training program, Road Skills Test, or will be licensed by the Secretary of State. Applicant is under no obligation to take the Road Skills Test with ABC Training and Testing. However, ABC students choosing to test with us may be eligible for a discount
**This agreement takes precedence over any and all previous written agreements and/or oral understanding that either party may have signed or understood was to have been in place. It is expressly agreed that the host organization, training organization and instructors shall not be held liable for any injury sustained by student before, during or after training. Student and parent agree to indemnify and hold harmless against all claims, damages, costs and expenses, including attorneys fees arising from or in connection with said training. With the knowledge and understanding of all of the above conditions, the parties to this agreement do hereby sign said agreement.
CONTRACT SIGNATURES
ABC Training and Testing Representative
First
Last
Student E-Signature
*
Date
*
MM slash DD slash YYYY
Parent/Guardian E-Signature
*
Date
*
MM slash DD slash YYYY
Segment 2 Registration Fee
*
Price:
Total
$0.00
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