Please Print
Date
Student's  Name
Program # 
Classroom Location
Dates of Class
Last Name
First Name
Middle Name
Age
Date of Birth
Student's Address
No.
Street
City
Zipcode
Home Phone Number
Work Phone (Parent or Guardian)
Parent's Name
Home Phone (Parent)
Address
City
Zip
Segment # 2 Contract
Course Provisions
1. Superior Home Leasing and Investments, Inc., dba Grace and Mercy 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
This school is required to be licensed by the Michigan Department of State, Driver Programs Division.  If you have a complaint which you cannot settle with this school, write: MICHIGAN DEPARTMENT OF STATE DRIVER, Programs Division, LANSING, MICHIGAN 48918.  COMPLETION OF DRIVER EDUCATION DOES NOT GUARANTEE QUALIFICATION FOR A DRIVER LICENSE.

For a student to participate in Segment #2, verification must be recieved 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                               which needs to be paid in full the first day of class.
2. The requirements to pass the course:  The student must do all assignments and pass the State Test with at least 70% correct. 
3.  The certificate replacement:  There will be a charge of $10.00 to replace a certificate previously issued.
4. In order to obtain the level 2 license you must also pass a road test conducted by a licensed third party tester.
5.  A photo copy of level 1 license is required as proof that you have had your level 1 license for at least 90 days.
6. We accept money orders, cash, cashier's checks, Visa, Mastercard and personal checks, but would rather not recieve personal checks, and certificate will be held for (10) ten full working days for personal check to clear  the bank.  We have experienced bouncing checks, so therefore if your check bounces you will be charged $50.00, in addition to whatever  else you owe for the course..
Refund Policy
The tuition for the Segment #2 is non-refundable.  If the student does not complete the course for any reason, he/she can apply the tuition towards a class at a later date at any of our locations.  The course must be taken in its entirety, previous attendance will not count.  Ths student can only begin a new Segment #2 course one additional time.without repaying.  If the student does not wish to continue for any reason there is no refund.
Student Signature_____________________________

Parent or Guardian Signature ______________________________________

School Representative  ______________________________________

Date of Contract ______________________________________
Click Control P to Print a copy