Segment 1 Online Registration Application & agreement for driver education and training Classroom instruction is to be provided at the Escanaba High School Behind-the-wheel instruction will commence and conclude at Escanaba Senior High School, 906 DRIVE,LLC will conduct behind-the-wheel instruction in a dual-controlled automobile, fully insured, covering each student in the program. Choose Class Date ---February 2020 Student First, Middle and Last Name (required) Address City State MIWI Zip Code We accept student's age of 14 years and 8 months so please choose age 15. Birth Date Age 15161718over School Attending Parent or Legal Guardian Full Name Parent or Guardian Address Student Cellphone Parent or Guardian phone Your Email Parents Email COURSE PROVISIONS 906 DRIVE, LLC will provide a minimum of 24 hours of classroom instruction, 6 hours of behind-the-wheel (BTW) instruction, and 4 hours of 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. TUITION Segment 1 Course: $385 (Online payment, Cash or Check) Down payment: $100 minimum with signed contract. Work Booklet Fee: $5.00 included in course fee Textbook Deposit: $20 (charged at end of class if damaged or not returned) Balance due: First day of class (online payment available) Refunds: Balance will be applied to a future Segment 1 class FEES Cancellation of Segment 1 Fee: $20.00 charge when transferring to another session Book Fee: $20.00 for any unreturned or damaged book Replacement: Segment One Completion Certificate: $10.00 Driving Appointment Cancellation Fee: $30 charge for each behind-the-wheel driving experience missed which was not cancelled 24 hours in advance. Student or parent must contact the office or instructor by leaving a voice-mail message. Additional Behind-the-Wheel Instruction: any extra drives beyond the contracted 6 hours will be charged at a rate of $40 per hour. State Exam Failure: If student fails exam (less than a 70%) a re-take fee of $30 will be administered. REQUIRED LANGUAGE NOTICE This driver education 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; www.michigan.gov/teendriver. Completion of driver education instruction does not guarantee qualification for a driver license. TERMS OF AGREEMENT 1. The student must be at least 14 years/8months of age by the first scheduled day of class. Verification by birth certificate is required. 2. The parent or guardian agrees to pay the total amount of $380 which must be paid in full by the first class. 3. Requirements to pass the course: all classroom tests with a minimum of 70%, state final test with a minimum of 70%, complete all homework and perform the required driving experience. If student does not achieve minimum grade requirement, student will be offered up to two retakes with a $30 re-take fee for each test administered. 4. Students must attend all classes and parent student meeting (24 hours total). If absent, student must make up the time during the stated make-up dates to total 24 hours. 5. I authorize 906 DRIVE to use my son/daughter’s picture for promotional purposes:YesNo In signing this contract, I do herein affirm that I understand, and am in agreement with the terms and conditions described. Student AgreementParent Agreement