1 Stop Better Driving School 27821 W 7 Mile rd. Livonia, MI 48152 (313) 740-7995 www.1stopbetterdrivingschool.com Office Hours: Monday – Friday, 9:00 a.m. – 5:00 p.m. Department of State Certification # P000499 Program Number #_____________ Classroom Location:_________________ Dates of Class_________________________ SEGMENT 2 CONTRACT Student ________________________________________________________ ______ ____________ Name Last First Middle Age Date of Birth Address _________________________________________ City______________________ Zip _________ Home Phone _________________________ Work Phone (Parent or Guardian) _________________________ Parent’s Name___________________________ Home Phone (Parent) ___________________________________ Address __________________________________________ City________________________ Zip ____________ COURSE PROVISIONS 1. 1 Stop Better Driving School will provide a minimum of 6 hours of classroom instruction provided by a certified instructor. Classroom instruction shall not exceed 2 hours per day. REQUIRED DEPARTMENT OF STATE INFORMATION NOTICE This provider is required to be certified by the Secretary of State. If you have any complaint which you cannot settle with this provider, write: Michigan Department of State, Driver Programs Division, Lansing, MI 48918. Completion of driver education instruction does not guarantee qualification for a driver license. For a student to participate in segment 2, verification must be received that the student has completed a minimum of 30 hours of driving (including 2 hours at night) with a licensed parent or guardian (or parent designee) on a level 1 license, which has been held for not less than 3 continuous months. TERMS 1. The parent or guardian agrees to pay the amount of $56.00 which needs to be paid in full by the start of class, payment methods are cash or money order only. Replacement certificates $10.00. 2. Requirements to pass the course: a. Final score of 70% or more on Michigan State Segment 2 Exam. b. Attendance of 6 hours classroom instruction and participation. 3. There is no cost for materials and supplies for the Segment 2 class. 4. In case of a student’s absence or emergency the school’s policy will be to retake the class. REFUND POLICY 1. 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 will be issued based on the following: Full refunds with written withdrawal before start of class or an excused emergency. b. There will be no partial refunds given. c. No refunds given as a result of student disciplinary actions. ________________________________________________ _____________________________________ Student Signature Parent or Guardian Signature ________________________________________________ ____________________________________ School Representative Signature Date of Contract RELEASE, WAIVER AND INDEMNIFICATION 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 this 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 Parent or legal guardian Date _____________________________________________________ ____________________ Signature of Student Date _____________________________________________________ ____________________ Signature of School Representative Date