Fillable All About Driving 4620 Dixie Highway Waterford, MI (All About Driving)

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All About Driving 4620 Dixie Highway Waterford, MI (All About Driving)

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All About Driving
4620 Dixie Highway
Waterford, MI 48329
248-623-0799
WWW.ALLABOUTDRIVING.COM
Department of State Certification #: P000652
O
ffice Hours:
By appointment only
ADULT CONTRACT
Name:___________________________________________________________________________________________________
Last First Middle Initial
Date of Birth:_______________________________________
Address:____________________________________________City:_______________________State:_______ Zip:___________
Phone:____________________________________________ Cell Phone:____________________________________________
Email:______________________________________________________________________________________
Emergency Contact:_________________________Relation:___________________Telephone:___________________________
TERMS OF AGREEMENT
All About Driving will provide hourly behind-the-wheel instruction in a dual-controlled automobile, fully
insured, (coverage includes the student and the instructor). Students must provide a copy of the valid driving
permit, issued by the Secretary of State, to All About Driving before we will schedule an appointment.
Students are required to have the valid driving permit, issued by the Secretary of State, at every lesson or All
About Driving will be unable to provide instruction.
Hourly fee $60.00.
Full payment is required on day of instruction. The school, All About Driving, will not refund any fee, or charge or any part thereof should the
school be ready, willing, and able to fulfill its part of the agreement. All About Driving reserves the right to cancel or reschedule at its sole
discretion.
“Notice: This school is required to be certified by the Secretary of State. 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 training instruction does not guarantee qualification for a driver license.”
In signing this contract, I do herein affirm that I understand and am in agreement with the terms and conditions
described.
Adult Student Signature Date License Number (TIP)
Provider Signature Date License Number (TIP) Issue Date
ALL ABOUT DRIVING
ADULT REGISTRATION FORM
Please Print
STUDENT FULL NAME:_________________________________________________________________
Last First Middle
ADDRESS: ______________________________ CITY: _________________ ZIP CODE: __________
PHONE_______________________
EMERGENCY CONTACT: __________________________________ PHONE: ______________________
1. Does the student require any special accommodations to participate in the behind-the-wheel
instruction i.e. adaptive devices, an interpreter, etc.)? Yes____ No____
If Yes, please explain: ____________________________________________________________
2. Is the student taking any medications that may affect his/her ability to drive a motor vehicle
safely?
Yes ____ No ____ If Yes, please describe ___________________________________________
3. Are there any medical conditions that would pose a concern with the student’s behind-the-wheel
instruction (epilepsy, asthma, color blindness, hearing loss)?
Yes ____ No ____ If Yes, please explain: ____________________________________________
4. Is the student’s visual acuity at least 20/40 corrected? Yes ____ No ____
5. In the last six months, has the student had a fainting spell, blackout, seizure, or other
uncontrolled loss of consciousness? Yes ____ No ____
6. In the last six months, has the student had a physical or mental condition which affected his/her
ability to drive a motor vehicle safely? Yes ____ No ____
If the answer to question 4 is no, or either of questions 5 or 6 is yes, then the student 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.
CERTIFICATION: I certify that the information on this form is true and accurate to the best of my knowledge.
_____________________________
STUDENT SIGNATURE
_____________________________
DATE
Student Driving Record for All About Driving
Check box if another student/adult must accompany student driver
NAME _____________________________________________ PROGRAM #___________________________________
Drive
I
n car familiarizati
on
Residential roadways (side streets)
Pedestrian alertness
Controlled & uncontrolled intersections
and parked cars
Left and right turns
Drive 1 Date
:
Start/End Times:
Instructor Name
Student Initials
Visual awareness of:
Signs, Pavement markings, Traffic lights and Brake lights
Reaction on red, Aim high in steering, Space cushion
Speed and Brake Control
Drive 2
Date
:
Start/End Times:
Instructor Name
Student Initials
Multiple lane changes (2 to 4 lanes)
Mirror (5 to 8 seconds) and Blind Spot Check
Following Distance, Variations of speed and Brake Control
Visual awareness of:
Signs, Pavement markings, Traffic lights and Brake lights
Reaction on red, Aim high in steering, Space cushion
Drive 3
Date
:
Start/End Times:
Instructor Name
Student Initials
Express
way;
highway/
interstate driving
Entrance & exit ramps, Merge lanes
Lane changes,
Mirror (5 to 8 seconds) and Blind Spot Check
Visual awareness of:
Signs, Pavement markings, Traffic lights and Brake lights
Reaction on red, Aim high in steering, Space cushion
Drive 4
Date
:
Start End /Times:
Instructor Name
Student Initials
Parking (perpendicular, reverse, diagonal, & parallel)
3-point turn
Drive 5
Date
:
Start/end Times:
Instructor Name
Student Initials
Final Evaluation
Drive 6
Da
te
:
Start/End Times:
Instructor Name
Student Initials
TOTAL HOURS DRIVEN:_______________________________ TOTAL HOURS OBSERVED:_____________________________
Instructor Signature___________________________________
All About Driving
BTW STUDENT OBSERVATION RECORD KEEPING – Segment 1
Student Name:_____________________ Program # ___________________
Date
Start:
End:
Student’s Comments:
Instructor Name:
____________________________________________________________
Total Observation
Time
Observing
Student’s
Initials
Date
Start:
End:
Student’s Comments:
Instructor Name:
_______________________________________________________________
Total Observation
Time
Observing
Student’s
Initials
Date
Start:
End:
Student’s Comments:
Instructor Name:
_______________________________________________________________
Total Observation
Time
Observing
Student’s
Initials
Date
Start:
End:
Student’s Comments:
Instructor Name:
_______________________________________________________________
Total Observation
Time
Observing
Student’s
Initials
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All About Driving 4620 Dixie Highway Waterford, MI (All About Driving)

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Completed 7 August 2021

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