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Capital City Vineyard Church Segment 1 Driver Education Training Registration

Student Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birthdate*

Segment 1 Driver Education Classes at Capital City Vineyard Church*

Other Information

Note if the student has any medical, physical, learning, or disability condition here.

Total

Refund Policy

To facilitate social distancing, Michigan Department of State has instituted a strict policy limiting the number of students that may be registered to attend Segment 1 and Segment 2 driver education classes.

Consequently, if you must drop out of a Segment 1 or 2 class and provide Driving Right with greater than 14 days of notice, Drive Right will refund 100% of the fee.

If you must drop out of a Segment 1 or 2 class and provide Driving Right with 14 days or less of notice, Drive Right will refund 65% of the fee.

Payment*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name