ENROLLMENT

Segment 2 Registration

Complete the form below to enroll in our Segment 2 Driver Education program.

1 Student & Parent Info

2 Waivers & Health

Review & Submit

Student Information

First Name *

Middle Name

Last Name *

Driver's License Number (Required) *

Street Address *

City *

ZIP Code *

Phone Number *

Birth Date *

Parent / Guardian Information

Full Name *

Email Address *

Street Address *

City *

ZIP Code *

Phone Number *

Emergency Contact

Full Name *

Phone Number *

Segment 2 Eligibility Confirmation

I confirm the student has completed at least 30 hours of driving (including 2 hours at night).

I confirm a driving log will be presented before or at the first class.

Initials (Parent/Student) *

I confirm the student has held a Level 1 License for at least 3 months.

Initials (Parent/Student) *

Accommodations / Medical

Does the student require classroom accommodations?

Yes No

If yes, please explain:

Signatures

Student Signature *

Sign Here

Clear

Date *

Parent / Guardian Signature *

Sign Here

Clear

Date *

Payment Information

Total Program Cost

$100

Payment Type *

Cash Check

Check Number (if applicable)

Segment 2 Program

$100

6 hours classroom instruction
3 required sessions
State-required course

Class Schedule

May 18 – May 20, 2026
3:45 PM – 5:45 PM

Kingsford High School
Room 102

Important Requirements

Must have Level 1 License for 3+ months
Must complete 30 driving hours (2 at night)
Driving log is required
Must attend ALL classes

What Happens Next

Confirmation email sent after enrollment
Class instructions will be emailed before the start date
Bring your driving log to the first class

Questions?

(906) 828-1945

We're happy to help!

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