Apple driving school

TEEN STUDENT CONTRACT

I, _________________________________________ agree to pay Apple Driving School Inc. (ADSI) $309.00 for a Segment One course in Driver’s Education. Additional driving may be purchased in advance of final drive or any time after successful completion of program for $50 per hour. Student is eligible for Segment Two after not less than 3 consecutive months with a Level One license. Apple Driving School will provide 24 hours of classroom experience, 6 hours of behind the wheel (BTW) training, and 4 hours of observation time. 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. All materials will be provided by ADSI. ADSI will provide full auto liability insurance while student is in our dual brake control cars. All ADSI instructors are certified by the Michigan Dept. of State to teach drivers education and have been fingerprinted by the FBI and Michigan State Police. Class must be paid for in full by the first day of class and may be paid by cash, check, or money order, or by credit card (on-line registration only). We reserve the right to hold the completion certificate until payment is received and/or a check clears the bank. There is a $35.00 fee for returned checks. There will be no refunds after the second day of class. All refund requests are to be made in writing and a $20 processing fee will be deducted from your refund. The processing fee will not be charged if ADSI cancels the class. There will be a $20 fee for non-returned or damaged books.

STUDENT LEGAL NAME_________________________________________________________________________________

(First) (Middle) (Last)

PARENT/LEGAL GUARDIAN ADDRESS________________________________________________________________________

(Street) (City) (Zip)
PHONE (parent or legal guardian)_______________________________BIRTHDATE___________________________________
DATES of CLASS_________________________________________________________________________________________
CLASSROOM LOCATION (address)_The International School, 28555 Middlebelt Rd, Farmington Hills_____________________
I hereby state that I have read and understand the above information and that student is at least 14 years and 8 months of age on or before the first day of class and will not reach 18 until after this program is completed. Student has no physical handicap or disability or takes no medications or drugs, which would impair or prevent them from driving a motor vehicle or would endanger the lives of others.

X_______________________________________X_______________________________________________

Student Signature Parent/Guardian Signature Date

Driving School Manager Signature Date

OFFICE HOURS ARE 9AM – 5PM MONDAY – FRIDAY
Please keep a copy for your records!

Apple Driving School Inc.

SEGMENT ONE REGISTRATION FORM

Please print

STUDENT FULL NAME: __________________________________________________________________

Last First Middle
ADDRESS: ____________________________________________CITY: ____________________________
ZIP CODE: ____________ HOME PHONE: __________________ CELL PHONE: ____________________
BIRTHDATE: _____________ AGE: (Years & Months) __________ (Verified by birth cert. copy we can keep)

Student must be at least 14 years and 8 months by the first day of class.
PARENT/GUARDIAN”S NAME: __________________________WORK PHONE: ___________________
EMERGENCY CONTACT: _______________________________ PHONE: _________________________

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 ______
   

2. 
   Does the student require any special accommodations to participate in the behind-the-wheel phase (i.e. adaptive devices, an interpreter, etc.)? Yes ______ No ______
   

3. 
   Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely? Yes ______ No ______ If yes, please describe: __________________________________________
   

4. 
   Are there any medical conditions that pose a concern with the student’s behind-the-wheel instruction (epilepsy, asthma, color blindness, hearing loss)?
   

5. 
   Is the student’s visual acuity at least 20/40 corrected? Yes ______ No ______
   

6. 
   In the last six months, has the student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness? Yes ______ No ______
   

7. 
   In the last 6 months, has the student had a physical or mental condition that affected his/her ability to drive a motor vehicle safely? Yes ______ No ______
   

If the answer to question 5 is no, or either of questions 6 or 7 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 257.309.

PARENT SIGNATURE STUDENT SIGNATURE