3913 Jackson Rd, Suite
Ann Arbor, MI  48103
(734) 389-0410

Office Hours: Mon – Fri 9-3 Sat and Sun by appointment

Drives are by appointment only

Department of State Certification # P000499


Name ______________________________________________________________________                    _______________
     Last                                                                First                                                               Middle Initial                                   Date of Birth

Address ______________________________________________          City_____________________         Zip ___________

Home Phone ______________________    Work Phone ______________________    Cell Phone ______________________

Emergency contact information ____________________________________________________________________________

TIP ________________________________________________________________________ EXP _____________________


1 Stop Better Driving School will provide behind-the-wheel instruction in a dual controlled automobile that is fully insured (coverage includes the student and
the instructor).

1.        The total cost is $60.00 an hour or 6 Hours for $350.00 or 2 consecutive hours $115.00.
Packages are refundable minus $60.00 hourly rate. Payment is due at the time of first instruction. Payments accepted are Cash, Money Order or Checks made
payable to 1 Stop Better Driving School.

NOTICE:  This provider is required to be certified by the Secretary of State.  If you have any complaint, which you can not settle with this school, write:
Michigan Department of State, Driver Programs Division, Lansing, MI 48918.  Completion of driver education does not guarantee qualification for a driver

In signing this contract, I do herein affirm that I understand, and am in agreement with the terms and conditions described.

_____________________________________________________                 _____________________________________
Student Signature                                                         Date

_____________________________________________________                 ____________________________________
School Representative Signature                                         Date     


The undersigned participant and his/her parent or legal guardian does hereby execute this release, waiver and indemnification for him/her, his/her heirs,
successors, representatives and assigns: and hereby agrees and represents as follows:
To release 1 STOP BETTER DRIVING SCHOOL, all employees, representatives and affiliates with this course from any and all liability, loss, damage, costs,
claims, and/or causes of action, including but not limited to all bodily injuries and property damage arising out of participation in 1 STOP BETTER DRIVING
SCHOOL driver education course.  It is being specifically understood that the program includes the operation and use by the undersigned participant and others
of automobiles.  The undersigned further agrees to indemnify 1 STOP BETTER DRIVING SCHOOL,  all employees, representatives and affiliates with the
course, and hold them harmless for any liability, loss, damage, costs, claim, judgment or settlement which may be brought or entered against them as a result of
the undersigned participation in said course.  This indemnification shall include attorney’s fees incurred in defending against any claim or judgment and  
incurred in negotiating any settlement.  It is understood and agreed that the undersigned shall have the opportunity to consent to any such settlement, provided,
however, that such consent shall not be unreasonably withheld.
_____________________________________________             _____________________________________
Signature of Student                                                                      Date
_____________________________________________             _____________________________________
Signature of School Representative                                              Date

                                                                                  ADULT BEHIND THE WHEEL RECORD KEEPING FORM

DRIVE # 1    
DATE                     INSTRUCTOR                                             STUDENT SIGNATURE                 TOTAL HOURS

DRIVE # 2     _______________________________________________________________________________________________
DATE                     INSTRUCTOR                                             STUDENT SIGNATURE                 TOTAL HOURS

DRIVE # 3     _______________________________________________________________________________________________
DATE                     INSTRUCTOR                                             STUDENT SIGNATURE                 TOTAL HOURS

DRIVE # 4     _______________________________________________________________________________________________
DATE                     INSTRUCTOR                                             STUDENT SIGNATURE                 TOTAL HOURS

DRIVE # 5    _______________________________________________________________________________________________
DATE                     INSTRUCTOR                                             STUDENT SIGNATURE                 TOTAL HOUR

DRIVE #6_________________________________________________________________________________________________
DATE                    INSTRUCTOR                                                STUDENT SIGNATURE                 TOTAL HOUR

                   Total Drive Hours purchased ________ Total Cost _________________ cash________ check_______ M O ______