VIRTUAL-SEGMENT TWO CLASS REGISTRATION
ONLINE: March 23, 24, 25 & 26; Monday, Tuesday, Wednesday= 4-6pm: LIVE ONLINE; Thursday, March 26=5-5:30pm IN-PERSON in Haslett
Class Code
This is the official class code that the State requires to be on your documents
Class Dates
First Name
*
Middle Name
*
Last Name
*
Birth Date
*
/
Month
/
Day
Year
Date Picker Icon
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When did you get your Level 1 License?
*
-
Month
-
Day
Year
Date Picker Icon
Driver's License #
This is near the top of your Level 1 License
Please take a picture of the front side of your Level 1 License
*
Browse Files
You must have your Level 1 License for at least 3 months to be eligible for class AND the date MUST BE LEGIBLE!
Cancel
of
Please take a picture/screen shot of your driving log.
*
Browse Files
You must have at least 30 hours to be eligible for class
Cancel
of
Where did you take Segment 1 class?
*
Mr. R’s Driving School
Central Driving School
Lansing Area Driving School (@Lansing Catholic)
Knox Driving School
Official Driving School
C & C Driving School
Mr. Bentley’s Driving School
Driving Right-Bath
Driving Right-East Lansing
Driving Right-Haslett
Driving Right-Laingsburg
Driving Right-Mason
Driving Right-Capital City Vineyard Church
Capital Area Driving School
Preston Driving School
Burcham Driving School
Other/Unknown
High School Attended
*
Haslett
Williamston
Okemos
East Lansing
Bath
Perry
Laingsburg
Lansing Catholic
Lansing Christian
Webberville
Fowlerville
Dansville
Mason
DeWitt
St. Johns
Lansing Eastern
Waverly
Lansing Sexton
Lansing Everett
Grand Ledge
Portland
Charlotte
Eaton Rapids
Potterville
Owosso
Leslie
Ingham Academy
Nextech Academy
Homeschooled
Other/Not on the list
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Parent/Guardian E-mail
*
This e-mail will receive a confirmation receipt. That email will also have the Zoom link you need to get into class -so KEEP TRACK OF IT!
Student or Secondary E-mail
*
This e-mail will ALSO receive a confirmation so you have more chances NOT to lose it!
Gender
Female
Male
Does the student require any special accommodations toparticipate in the classroom phase (i.e., test being read to him/her, an interpreter, seating arrangements, etc.)?
*
Yes
No
If 'Yes', please explain:
Comments or Extra Information
Barter proposals would go here too!!
Link to Zoom Links & Study Guide & Quizlet & Make-up classes
Follow this address to the Zoom links for class, the SEG 2 Study Guide & the Quizlet
Future Info From Mr.R's
Yes, I want to receive updates via e-mail!
Parent Signature
This is signing that you have read and agree to the terms & conditions
Student Signature
This is signing that you have read and agree to the terms & conditions
Payment
*
Pay now with card
Pay by phone/drop off cash/check
CHECKOUT
*
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SEGMENT TWO CLASS
$
100.00
Enter coupon
Apply
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: