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Defensive Driving Online Registration
Dallas Hiram Defensive Driving Registration Form
Unique ID
The State of Georgia is now allowing students to take courses remotely from home! If you plan on completing your course remotely, there are certain guidelines you need to know:
1. You must use a device with a camera & microphone. Apple iPhones, Android phones, Laptop computers, desktop computers with webcams, are all acceptable as long as the camera & microphone is functional. Keep your device plugged in!
2. Remote classes require the usage of a third-party app. Please check your App Store for the WebEx Meetings App or download for your computer here: https://www.webex.com/downloads/
Student Information
Enter the information below as it would appear on the students drivers license!
Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
(Required)
Email
(Required)
License Number
(Required)
Attach a copy of a Photo ID. You can also e-mail a copy to
staff@dallashiramduischool.com
. You can scan it in or take a clear photo with your smartphone camera.
File
Max. file size: 64 MB.
State Approved Defensive Driving Class
A defensive driving class can be taken for a variety of reasons. Be sure to indicate why you are taking the class below.
Your reason for taking the course:
(Required)
Court Ordered
Insurance Reduction
License Reinstatement
DDS Points Reduction
Other (Probation, etc.)
If you are unsure why you are taking the defensive driving class feel free to give the school office a call at 770-443-1644 and we can help!
Choose Your Preferred Class Date
(Required)
October 10th & 11th (Tues/Wed) 6:30PM-9:30PM EST 2023
October 24th & 25th (Tues/Wed) 6:30PM-9:30PM EST 2023
November 7th & 8th (Tues/Wed) 6:30PM-9:30PM EST 2023
November 21st & 22nd (Tues/Wed) 6:30PM-9:30PM EST 2023
December 5th & 6th (Tues/Wed) 6:30PM-9:30PM EST 2023
December 19th & 20th (Tues/Wed) 6:30PM-9:30PM EST 2023
January 2nd & 3rd (Tues/Wed) 6:30PM-9:30PM EST 2024
I prefer to take my class by
(Required)
Online Tele-Classroom
In-Person / In-Classroom
Course dates are not final until you are contacted by our staff. We do our best to accommodate last minute registrations.
(Required)
I understand that I will be contacted to finalize these dates.
Defensive Driving (Driver Improvement) Terms of Agreement
I, the undersigned student, agree to complete the above course, consisting of 2 classes for 3 hours each, totaling 6 hours of instruction by the above-name driver improvement clinic. It is understood that this Clinic is certified by the Georgia Department of Driver Services (DDS) in accordance with Georgia Law Title §40-5-80 (DRIVER IMPROVEMENT ACT) and the rules and regulations adopted there under and that each instructor is certified by the DDS. This course is approved by the DDS.
The student’s successful completion of the above-named course requires each of the following:
1. Attendance at all classes sober and free from illicit drugs.
2. Attendance on time for all sessions.
3. Reasonable attentiveness and participation in all classes.
4. Attendance at all sessions unless medically excused.
5. All sessions must be completed within 60 days.
6. Successfully passing a written or oral examination with a grade of at least 70.
This driver improvement clinic will not refund any tuition or part of tuition if the Clinic is ready, willing, and able to fulfill its part of this contract. I understand that if I fail to comply with the terms and conditions of this agreement, I am in breach of contract and the school will not be under any obligation to fulfill the terms of this contract, and may, at its option, terminate this agreement immediately.
It is agreed that an owner, instructor, or employee of this Clinic shall not give the impression to a student that upon completion of their instruction this Clinic will guarantee the securing of a driver’s license to operate a motor vehicle. However, immediately upon the student’s successful completion of the course as described above, the Clinic agrees to provide certification of said completion to the student.
This Clinic has and will maintain for the protection of the contractual rights of the student a performance bond in the principal sum of ten thousand ($10,000.00) dollars for the students to be written by a company authorized to do business in the state of Georgia.
This agreement constitutes the contract between the above-named driver improvement clinic and the above-named student and no verbal statements will be recognized.
Signature
(Required)
Payment Information
State Approved Defensive Driving Class
Price:
Credit Card
(Required)
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Security Code
Cardholder Name
Signature
(Required)
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