Truck Contract - Word - Michigan



Student: (last)(first)(middle) Address: City: Zip:Home Phone: Age: D.O.B.: Driver License #: CLP Issuance Date: Ex. Date: Emergency Contact: Phone #: COURSE PROVISIONS Doing It Right Driving School, Inc. will provide a minimum of 80 hours of classroom instruction, 20 hours of range practice (yard), 20 hours of driving observation, and 30 hours of behind-the-wheel (BTW) instruction. Classes will normally run 8 hours/day Monday through Thursday for 5 weeks (150 hours)*. Doing It Right Driving School, Inc. will conduct the behind-the-wheel instruction in a tractor-trailer that is fully insured to cover each student enrolled in the program. Students must obtain a Commercial Learner’s Permit (CLP) by achieving a score of 80% or higher on the State of Michigan “Knowledge” test.Classroom instruction for this program will begin on and end on . Start Time: _____ End: _____All instruction – classroom, range, and BTW – will be given at 123 Main Street, Any Town, MI.COURSE TERMS The total cost of this course is $5995.00. This includes all course materials, DOT physical examination and drug screen (arranged by Doing It Right), basic CLP fee, plus the Driver Testing Business fee and the use of a Doing It Right tractor – trailer for one State of Michigan approved CDL driver license test. The student is responsible for the license fee, any endorsements beyond the basic CDL – A minimum requirements, and all costs associated with subsequent CDL driver license tests.*A non-refundable deposit of $500.00 is required when this contract is signed. Full payment of the balance ($5,495) by cash, check, money order, or credit card must be made by the first day of class.*Students must present a current Medical Examiner’s Certificate (MCSA-5876) and drug screen at the time the course begins. Contact the Doing It Right office to make arrangements to complete these in time for your course*.In the event that a class is cancelled by Doing It Right, it will be made-up on a Friday or Saturday*.Up to 10 hours of classroom instruction missed due to the student’s absence can be made-up via homework assignments or by attending the same session in a subsequent program. One BTW session may be cancelled by the student and will be made-up at a time mutually agreed upon by the student and Doing It Right. If the session is cancelled with at least 24 hours’ notice, there will be no additional charge. For additional cancelled sessions and for any session cancelled with less than 24 hours’ notice, a cancellation fee of $100.00 will be charged*. REQUIREMENTS TO PASSING THE COURSE A score of 80% on each course segments (Federal Regulations, Vehicle Inspection, Range Skills, & Over-The-Road) is required to pass the course. Certificates of Completion will be presented to those who pass the course*.REFUND POLICY Students who withdraw before the first 40 hours of instruction will receive a refund of $5,000.00*.Students who withdraw after 40 hours and before 80 hours of instruction will receive a refund of $3,000.00*. No refunds will be given to students who withdraw after 80 hours of instruction*. ACCOMMODATIONS/MEDICAL CONDITIONS Does the Student require any special accommodations to participate in the classroom phase (e.g., test being read, interpreter, etc.)? Yes No If Yes, please explain: Does the Student require any special accommodations to participate in the BTW phase (e.g., adaptive devices, interpreter, etc.)? Yes No If Yes, please explain: Are there any medical conditions that would pose a concern with the Student’s BTW instruction (e.g., epilepsy, color blindness, etc.)? Yes No If Yes, please explain: Is the Student taking any medications that may affect his/her ability to drive a motor vehicle safely? Yes No If Yes, please explain: In the last six months, has the Student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness? Yes No In the last six months, has the Student had a physical or mental condition which would affect his/her ability to drive a motor vehicle safely? Yes No If the answer to any of questions 5 – 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 operate a commercial motor vehicle as that term is defined in section 7a of the Michigan Vehicle Code, 1949 PA 300, MCL 257.7a.Date: Student Signature:Date: By: Printed Provider Name Signature of Provider Owner Title ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download