Okemos High School Segment 1 Registration Packet. Thanks for choosing Central Driving School!!

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1 Okemos High School Segment 1 Registration Packet Thanks for choosing Central Driving School!! EASY REGISTRATION PROCESS: 1. Choose a class session that works with your schedule from the options listed in this packet. Check our website to verify the dates, times, and availability. 2. Read and fully complete entire registration packet and make a copy for your records. 3. If it s prior to 7 days before the course begins, mail pages 5-8, the tuition payment for the course, and a copy of the student s birth certificate to our mailing address: Central Driving School P.O Box 231 If it s within 7 days before the class begins, please drop off pages 5-8, tuition payment, and a copy of the student s birth certificate at our office located at: 3945 Okemos Road, Suite A-5 Okemos, MI You re Registered! If there is any problem, we will contact you. Plan to attend your chosen course the first day. Courses are held in room B-113 at Okemos High School. Please call if you have any questions or problems. 2 Ways to SAVE! 1. Save by Registering Early! ** See page 5 of this packet for more information** 2. Save by pre-paying for Segment 2 when you pay for Segment 1! You can save $10.00 off combined tuition by pre-paying for segment 2 when you pay for Segment 1. See our Payment Information Form in this packet for instructions. Pay now and select and register for your Segment 2 course later!

2 TEEN SEGMENT 1 COURSE SCHEDULE Central Driving School Inc. has been educating and preparing young drivers in the mid-michigan area since 1981, and is dedicated to providing quality instruction in a safe and friendly environment. Segment 1 and Segment 2 courses are offered at Okemos High School. Our free standing office is located at 3945 Okemos Road, Suite A-5, Okemos, MI CDS is also a State of Michigan Certified Third Party Road Testing Provider. Central Driving School proudly supports all mid-michigan students. Students from ANY area high school, home school, private school, or parochial school are eligible and welcome to enroll in any of our courses, regardless of location. Program includes 24 hours of classroom instruction and 6 hours of driving, and 4 hours of observation. Students must be 14 years, 8 months old BY THE FIRST DAY OF CLASS. Student Name Last First Date of Birth **Student MUST be 14 years, 8 months by the first day of class.** Course : 3:15-5:15 p.m. Dates: March 4-7, 11-14, March Signed registration packets must be turned in by the first day of class Current course offerings are listed below for your convenience Course PM: 3:15-5:15 p.m. Course : 3:15-5:15 p.m. Dates: April 8-11, 15-18, Dates: May 6-9, 13-16, April May Course AM: 8:00-10:00 a.m. Dates: June 13-14, 17-21, June 2019 AM Course PM: 6:00-8:00 p.m. Dates: June 13-14, 17-21, June 2019 PM Course AM: 8:00-10:00 a.m. Dates: July 8-11, 15-18, July 2019 AM Course PM: 6:00-8:00 p.m. Dates: July 8-11, 15-18, July 2019 PM Course : 8:00-10:00 a.m. Dates: July 29-Aug. 1, 5-8, July/Aug Course : 3:15-5:15 p.m. Dates: Sept. 3-6, 9-12, September Classroom instruction Road instruction Each student is required to complete 6 hours of road instruction based on instructor availability. *If you are using a printed copy of this form, please verify our current dates, times, and prices on our website Page 2 of 8

3 Course : 3:15-5:15 p.m. Dates: Sept. 30-Oct. 3, 7-10, September/October Course : 3:15-5:15 p.m. Dates: Nov.4-7, 11-14, November Course : 3:15-5:15 p.m. Dates: Dec. 2-5, 9-12, December Classroom instruction Road instruction Each student is required to complete 6 hours of road instruction based on instructor availability. *If you are using a printed copy of this form, please verify our current dates, times, and prices on our website Page 3 of 8

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5 Okemos High School Segment 1 Registration Packet Office Hours: By appointment Department of State Certification # P TUITION INFORMATION TUITION: - $ payable by cash/check/ money order by the first day of class ($ for credit card payments). Early Registration/Payment Incentive: -$ payable by cash/check/money order if signed registration forms and payment in full are submitted by ONE FULL WEEK in advance of class ($ for credit card payments). Availability for walk-ins may be limited based on preregistered class size. Courses with less than 10 registered students may be cancelled or rescheduled. (Prices subject to change; please verify current pricing on our website). SEGMENT 1 CONTRACT Course Number: Classroom Location: Okemos High School Dates of Class: Make checks payable to Central Driving School Send Registration and payment by mail to: Central Driving School PO Box 231 Student Name Last First Middle Age Date of Birth Address (For class communication and updates) Address City Zip Home Phone (Parent/Guardian Parent s Name Work Phone (Parent or Guardian) Secondary Home Phone (Parent) Address City Zip COURSE PROVISIONS Central Driving School, Inc. will provide a minimum of 24 hours of classroom instruction, 6 hours of behind-the-wheel (BTW) instruction, and 4 hours observation time in a dual controlled automobile, fully insured, covering each student enrolled in the program. Classroom instruction must be a minimum of 3 weeks in length. BTW instruction shall not begin until the student has received a minimum of 4 hours of classroom instruction. BTW instruction must be completed no later than 3 weeks after the classroom instruction has been completed. REQUIRED LANGUAGE NOTICE This provider is required to be certified by the Secretary of State. If you have any complaint that cannot be settled with the provider, please complete the Driver Education Complaint form found on the Department of State website; Completion of the driver education instruction does not guarantee qualification for a driver license. TERMS 1. The student must be at least 14 years-8 months of age by the first scheduled day of class (verification by birth certificate required). Please mail birth certificate photo copy with registration forms. 2. The parent or guardian agrees to pay the amount of $355.00, payable by cash, check, or money order on the first day of class ($ for credit card payments). Have signed registration forms and payment in full turned in more than one week before class and a $20 cash credit will be applied to your account (making tuition $ for cash, check, or money order payments, $ for credit card payments). Checks or Money Orders should be made payable to: Central Driving School, and mailed to the address above. Returned checks from lending institutions will be charged a $25 NSF fee. 3. Central Driving School, Inc. accepts cash, personal check, money order, credit card. 4. Requirements to pass the course: a. Behind-the-wheel: Demonstration of proficiency of skills listed in the Michigan Department of State Driver Education Curriculum Guide, Section 5B Segment 1. b. Classroom instruction: Successful completion (70% or better) of the DEPARTMENT of STATE TEST. Successful completion (80% or better) on a written test from SOS What Every Driver Must Know booklet. c. Required attendance (classroom 24 hours, road 6 hours/4 hours observation time) per State of Michigan requirements. d. Successful completion of homework as required. 5. The required score to pass the STATE TEST is 70%. 6. The cost of materials and supplies for the class is included in the fee. Student is responsible for lost, stolen, or damaged textbook to be used in the class. A $25.00 replacement fee will be charged and collected prior to certificate being issued. Rev OVER-- Page 5 of 8

6 7. In the event of a driving appointment no-show or cancellation without 24 hour notice, a fee of $40 will be charged. This fee must be paid prior to any additional driving being given or certificate being issued. 8. A student may miss up to two days with a reasonable excuse (e.g. illness, family matter). The days must be made up at the end of the class or the next scheduled Segment 1 class immediately thereafter. 9. Students are expected to be present for ALL scheduled driving/observation/classroom sessions. In the event of an absence, the student must make up the driving or same missed class session in the next available offered Segment I course. A Segment I Certificate of Completion cannot be issued until all class/driving/observations are made up. Any missed, repeated or incomplete requirements must be made up by the next class offering, usually within 60 days. 10. In the event of a school closing (e.g., a snow day), classes at that high school location will also be cancelled for the day. 11. At least two students will be in the driver education vehicle whenever behind-the-wheel instruction is provided, unless a waiver is signed by the parent or guardian. 12. The 6 hours of driving and 4 hours of observation will be conducted outside of classroom hours. The student must be available to participate in behind-the-wheel instruction after school and on weekends. 13. No electronic devices of any kind may be used in or during class or in the car unless requested by the instructor. This includes, but is not limited to: computers, cell phones (including text messaging), or tablets. All devices must be turned off and stored away if brought into the classroom. The instructor may request all devices be collected before the lesson. 14. Any student, who comes into class more than 10 minutes late, returns to class late after the short break, or leaves the classroom before the designated break time(s); will be marked as tardy. Two (2) tardies will count as one absence. 15. All conversations that are not part of the classroom lecture or topic discussions will not be permitted. Those who continue to talk, interrupt, or disrespect the class or guest speakers will be marked as not participating in classroom lectures or discussions. Any continued interruptions will result in dismissal from the course. 16. Sleeping in class or working on other activities while in class will be considered as being absent. 17. The instructor retains the authority to devise a room seating chart or ask students to sit in certain seats at any time during the course. 18. Any student who is disrespectful to an instructor, guest speaker, another student, or an employee of the school may be dismissed from the class. 19. Please pick students up on time, as instructors will not stay late and have to lock the classroom when they leave. REFUND POLICY If for any reason you decide to withdraw from the course before its completion, your refund will be based on the following: a. A full refund minus a $40.00 administrative fee will be issued if the student withdraws from the class prior to the start of the first classroom session. b. A partial refund will be issued based on the following: Week one classroom only-full refund minus $ Week two classroom only-full refund minus $ Week three classroom only-full refund minus $ c. A $40 fee will also be assessed for every driving session, no-show, or cancellation without a 24 hour notice that occurs prior to the withdrawal. I have read and agree to the terms and policies outlined above. Student Signature Parent or Guardian Signature School Representative Signature Date of Contract The law requires that Central Driving School provide behind-the-wheel instruction with not less than 2 students in the training vehicle. That requirement may be waived if the parent/legal guardian signs the waiver agreement below, allowing for their son or daughter to be given individualized lessons. The student must still complete at least four hours of observation time as a passenger in a driver education vehicle being driven by another driver education student. By signing below, I, Parent waiver agreement for individualized on-the-road instruction., authorize Printed name of Parent/Guardian Central Driving School to allow a certified instructor employed by the provider to offer my child on-the-road driving instruction without another passenger in the vehicle. Signature of Parent/Guardian Date Signature of Provider Page 6 of 8

7 CENTRAL DRIVING SCHOOL REGISTRATION/HEALTH FORM Course # Month: Time: Student Full Name (Print): Last First Middle (no initials) Address: City: Zip: Phone # ( ) Work/Cell # ( ) Birthdate: M D Y (Student must be at least 14 years and 8 months by the first day of class) Photo copy of Birth Certificate, Passport or Michigan I.D. attached? Yes / No Gender: M / F Parent/Guardian Name: Home/Cell # ( ) Last First Emergency Contact: Home/Cell # ( ) Last First A completed: Segment I Registration Form, Segment I Contract and this form should be mailed along with the tuition and a photocopy of the student s birth certificate, or passport, or Michigan I.D. to the address listed on the course offering sheet. 1. Does the student require any special accommodations to participate in the classroom phase (i.e., test being read to him/her, an interpreter, seating arrangements, etc.)? Yes No If yes, please explain: 2. Does the student curently have an IEP or 504 Plan in place? Yes No If yes, please provide more details: 3. Does the student require any special accommodations to participate in the behind-the-wheel phase (i.e. adaptive devices, an interpreter, etc.)? Yes No If yes, please explain: 4. Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely? Yes No If yes, please describe 5. Are there any medical conditions that would pose a concern with the student s behind-the-wheel instruction (epilepsy, asthma, color blindness, hearing loss)? Yes No If yes, please explain: 6. Is the student s visual acuity at least 20/40 corrected? Yes No Comments: 7. In the last six months, has the student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness? Yes No Comments: 8. In the last six months, has the student had a physical or mental condition which affected his/her ability to drive a motor vehicle safely? Yes No Comments: If the answer to question 6 is no, or either of questions 7 or 8 is yes, then the parent/guardian must provide a letter signed by the student s physician indicating that the condition has been corrected and/or is under control, and the student meets the physical and mental requirements for a motor vehicle operator s license under Section 309 of the Michigan Vehicle Code, 1949 PA 300, MCL CERTIFICATION: I certify that the information on this form is true and accurate to the best of my knowledge. Parent/Guardian Signature Student Signature Date (MM/DD/YY) Page 7 of 8

8 Payment Information Form for Segment 1 Payments Bonus Incentive: Pay for Segment 2 NOW and save $10.00 on tuition! ***Pay now and schedule and register for Segment 2 at a later date. Just let us know then you ve prepaid*** Would you like to prepay for Segment 2 and combine that payment with this segment 1 payment? Segment 1 payment ($55 if paying by credit card) Simply add $50 onto this YES NO Your Payment method: check/money order Credit card ** If paying by credit card, please complete the following information Card Type: MasterCard VISA Discover AMEX Cardholder Name (as shown on card): Card Number: Expiration Date (mm/yy): Cardholder ZIP Code (from credit card billing address): CWV Code (3 digit code on back of card: I, authorize Central Driving School to charge my credit card above for the agreed upon charges. I understand that this is a one time charge. Customer Signature Date Date of charge: For Office Use Only: Initials: Page 8 of 8 Authorization Information: