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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)

Address(Required)

Street Address Address Line 2 City 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)

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

Card Number

Expiration Date

Security Code Cardholder Name

Signature(Required)

20-Hour Risk Reduction Class Online Registration

Step 1 of 2

Unique ID

Student Information

Enter the information below as it would appear on your Driver's License or State Issued Photo ID. If you have a DDS Identification Card, the ID Number is the same as your License Number.

Name(Required)

First Last

Student Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

License Number / ID Number(Required)

License / ID State(Required)

State

Choose Your Preferred Class Date

In the drop-down below, select your preferred class date. Most classes are Saturday/Sunday 9AM-6PM and Monday evening, 6:30PM-10:30PM. Classes are held every week except for some major holidays. Call the school office at 404-981-4384 if you have any questions!

Select Your Course Dates

Course dates are not final until you are contacted by our staff.(Required)

I understand that I will be contacted to finalize these dates.

Important Notice About This Course

All students must complete an in-person (OR ONLINE) survey (Assessment Component of the class) at the school office (OR ONLINE) before the first day of class. For most class schedules, you will need to come to the school office by 5PM on Friday at the latest to be able to attend class for the weekend.

**NOTE: AS OF 3/16/2020 DUE TO THE CURRENT HEALTH CRISIS THE STATE OF GEORGIA ALLOWS THIS SURVEY TO BE COMPLETED ONLINE. YOUR RECEIPT FOR THE PROGRAM WILL INCLUDE A LINK TO COMPLETE THIS ONLINE. ONLINE NEEDS SURVEYS MUST BE COMPLETED BY 4PM FRIDAY AS THEY ARE UTILIZED IN CLASS.**

There are no possible exceptions, students are required by the State of Georgia to complete this assessment component in-person (OR ONLINE). By signing up for this course, you understand that you will be required to come to the school office during regular office hours before your first day of class to be able to attend the course.

Students who arrive on the morning of class and have not completed this part of the course ahead of time will be turned away. There are no refunds, whether partial or in full, for any part of the course due to this strict enforcement of this State of Georgia rule.

School office hours are Monday-Friday, 9AM-6PM. The school office can be reached at 404-981-4384.

I Understand the Important Notice(Required)

I understand that I am required to complete the assessment portion of the course in-person during school office hours before my first day of class

20-Hour Risk Reduction Course Online Registration Terms of Agreement

By registering for the Risk Reduction course online, you agree to the following Terms of Agreement:
1. After course registration any fee or tuition costs are non-refundable and non-transferable If you are unsure if you need a Risk Reduction course, do not complete this registration and please contact the school office at 404-981-4384.
2. You will be required to visit the school office during regular office hours to complete the assessment component of the course before your class dates.

The above-named student/offender does hereby agree to the following conditions: By signing below, you are affirming that you have read, understand and are willing to comply with each condition specified.

• To arrive on time for each Session. Students/offenders arriving late will not be admitted.
• To be sober and drug free.
• To attend all sessions in sequence as scheduled. A student/offender is not allowed to attend the next session after missing a class.
• That student/offender must pass the final exam with a grade of 70% or more in order to obtain a Certificate of Completion.

Risk Reduction Intervention Component Contract

The above-named program is bound by the following conditions:
By signing below, the Program Official is affirming that they have read, understand and is willing to comply with each condition specified.

• A minimum of five (5) paid Intervention contracts are required to hold a course. In the event a course is cancelled, the Student/Offender is entitled to a full refund of course fees. The Student/Offender may opt to attend a future course offered by the Program or have his or her assessment results transferred to another Program of his or her choice at no fee.
• Course fees will not be refunded if the Program is willing and able to perform all conditions documented in this contract.
• No agent of this Program shall subject the Student/Offender to solicitation of any product or services.
• No agent of this Program shall imply to any Student/Offender that completion of this course will guarantee reinstatement of a driver’s license. However, this Program shall issue a “Certificate of Completion” to the above-named Student/Offender at the end of the class when all course requirements have been satisfactorily completed.
• This Program has and maintains, for the protection of the contractual rights of the Students/Offenders, a surety bond in the amount of $10,000 per program location written by a bonding company authorized to do business in the state of Georgia.

I understand that this agreement constitutes the entire Intervention contract between the above-named DUI, Alcohol or Drug Use Risk Reduction Program and the above-named Student. No verbal modifications will be recognized. I understand my respective responsibilities and agree to abide by the terms of this contract.

Course fees are statutorily mandated. Programs are allowed to charge a fee of up to $20.00 for replacement certificate, pursuant to Ga. Admin. Comp. Ch. 375-5-6-.23a(16)

RISK REDUCTION ASSESSSMENT COMPONENT CONTRACT

I, the undersigned Student/Offender, agree to complete the Assessment component administered by the above -named DUI Alcohol or Drug Use Risk Reduction Program. It is understood that this Program is certified by the Department of Driver Services.

The above-named student/offender does hereby agree to the following conditions:

By signing below, you are affirming that you have read, understand and are willing to comply with each condition specified.

• Assessment results are valid for one (1) year immediately following completion of the Assessment. If the Student/Offender does not enroll in the Intervention Component within on (1) year of completing the Assessment, another Assessment and Assessment fee will be required.
• This Assessment is valid only for the conviction(s) and/or plea(s) of nolo contendere for which you are currently enrolling. Any other conviction(s) and/or plea(s) of nolo contendere will require an additional Assessment.
• The Assessment results cannot be transferred to any other certificate program, including programs under the same ownership. The student/offender must be prepared to complete the Intervention Component at the location where the Assessment was taken. Programs must have a minimum of five paid Interventions contracts to administer an Intervention Component. In the event a program has to cancel a class for which the Student/Offender has enrolled and paid; they are entitled to have the Assessment results transferred one time to any certified Risk Reduction Program in the state.
• To complete the Assessment component at least 30 minutes prior to the beginning of the Intervention Component.
• To transfer the Assessment results to a Clinical Evaluator, there may be an additional fee up to $25.

ABOVE-NAMED PROGRAM AGREES TO THE FOLLOWING CONDITIONS:

By signing below, program official is affirming that he/she has read, understands and is willing to comply with each condition specified.

• This Program has, and shall maintain, to protect the contractual rights of students/offenders, a performance bond in the face amount of $10,000 per program location written by a bonding company authorized to do business in the State of Georgia.
• This Program will not refund any fees if the Program is willing and able to fulfill all terms of this contract.
• This Program shall provide the Student/Offender with a written schedule of classes for the current quarter, to include dates, times and location of class. The Student/Offender shall receive this information prior to the Assessment Component.
• Upon receipt of the transfer fee (if required) and signed authorization, the program shall forward the Assessment results to the chosen Clinical Evaluator within five (5) business days.

This agreement constitutes the contract between the above-named DUI Alcohol or Drug Use Risk Reduction Program and the above-named Student/Offender. No verbal statement will be recognized.

Assessment fees are set by Georgia statute. No program may deviate from set fees.

Upon completion of this form, you will be asked to complete an e-signature and payment. Once registration, signature and payment is complete, THIS CONTRACT IS A RECEIPT FOR PAYMENT OF ALL COURSE FEES.

Accept Terms(Required)

I agree to the Terms of Agreement.

Teleconferencing and Remote Classes

During the current health crisis, the State of Georgia is now allowing students to take courses remotely, including completing the NEEDS Survey online. 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. Laptop computers, desktop computers with webcams, Apple iPhones and Android phones are all acceptable as long as the camera 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/

3. Your NEEDS Survey must be complete by 4PM the Friday before class. Sign up early and complete the survey ASAP!

4. If you have technology issues, you are welcome to attend class in-person, but we strongly recommend teleconferencing during the current health crisis.

Teleconferencing or remote classes require a device with a working camera & microphone(Required)

I understand.

You must install the WebEx Meetings software or app to attend remotely(Required)

I understand.

Your NEEDS Survey link will be in your receipt e-mail. Complete it by 4pm Friday.(Required)

I understand.

Signature

State Licensed 20-Hour Risk Reduction Course: $360.00

Courses are not refundable or transferable(Required)

I understand that online payments are not refundable or transferable.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Course Price

Price:

IMPORTANT STUDENT/OFFENDER INFORMATION

RC-RRP-500 (04/13)

Georgia law requires anyone whose Georgia driver’s license or driving privileges have been suspended or revoked as a result of certain alcohol and drug violations, including Driving Under the Influence (DUI) and violating Georgia’s Controlled Substances Act, to successfully complete a DUI Alcohol or Drug Use Risk Reduction Program from a certified program and show proof thereof as a condition of reinstatement. Individuals charged with or convicted of other offenses may also be required to complete a Risk Reduction Program at the discretion of the court or as a condition of probation.

COMPLETION OF THE DUI ALCOHOL OR DRUG USE RISK REDUCTION PROGRAM

The Georgia Risk Reduction Program consists of two (2) components: the Assessment Component and the 20-hour Intervention Component. The Assessment Component consists of a questionnaire, the results of which are used by the Instructor of your Intervention Component to address issues concerning your beliefs and behaviors related to drugs and alcohol and driving. The results of your Assessment Component are confidential, and will not appear on your driving history. If you have questions, please talk to your Instructor after you begin class. You will be issued a certificate of completion only after you successfully complete both the Assessment and Intervention Components. Student/Offender must arrive on time for all sessions of the 20-hour class. An excused absence includes, but is not necessarily limited to, emergency military leave, a medical emergency involving a student/offender or an immediate family member thereof, the death of a student’s immediate family member, or a bona fide emergency documented in writing and approved by the Program Director or Owner. The student must provide a written excuse from a doctor, military commanding officer, or documentation of any other emergency acceptable to the Program. If the absence is excused, the student may be rescheduled and begin at the missed session. O.C.G.A. §40-5-81(a) expressly prohibits judges, probation officers, law enforcement officers, and other court employees from requiring attendance of a particular Risk Reduction Program. However, a judge or probation officer may require a copy of the certificate of completion as part of the sentence in a criminal case. Additionally, a judge or probation officer may require attendance of another substance abuse program.

CLINICAL EVALUATION AND SUBSTANCE ABUSE TREATMENT

Effective July 1, 2008, all first-time DUI offenders are required to obtain clinical evaluations, unless waived by the court. Depending on the results of the clinical evaluation, a student/offender may be required to complete a substance abuse treatment program. DUI offenders who get a second or subsequent DUI within a 10-year period are required, as a condition of license reinstatement (pursuant to O.C.G.A. § 40-5-63.1), to get a clinical evaluation, and if indicated by the evaluation, complete a substance abuse treatment program. Clinical evaluations and substance abuse treatment programs are not the same as a Risk Reduction Intervention class. Clinical Evaluators and Treatment Providers are regulated by the DUI Intervention Program, which is part of the Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD). Any questions regarding the clinical evaluation process or the substance abuse treatment program should be directed them. To obtain reinstatement information contact the Department of Driver Services at 678-413-8400. Some Risk Reduction Programs may have a Clinical Evaluator on staff, but this does not obligate the offender to use that Clinical Evaluator. Risk Reduction Program providers should supply a registry of approved clinical evaluators and treatment providers in the area. A list can be viewed online at the following website: http://www.mop.uga.edu/cetp/DUIIPwebsite/index.htm. After a Clinical Evaluator has been selected, the offender must sign an “Authorization for the Transfer and/or Release” form to allow the Risk Reduction Program to send a copy of the assessment to the Clinical Evaluator. Risk Reduction Programs may charge a fee up to $25 to transfer assessment results to a Clinical Evaluator. Neither the Risk Reduction Program nor the Clinical Evaluator may make referrals to a particular treatment provider. I have read the above information, or the program has read it to me and I have received a copy of this form. The program has given me a class schedule showing the dates and times for the 20-hour Intervention Component.

Signature

REGISTER TODAY

Dallas Hiram Defensive Driving Registration Form

Student Information

State Approved Defensive Driving Class

Defensive Driving (Driver Improvement) Terms of Agreement

Payment Information

20-Hour Risk Reduction Class Online Registration

Student Information

Choose Your Preferred Class Date

Important Notice About This Course

20-Hour Risk Reduction Course Online Registration Terms of Agreement

Teleconferencing and Remote Classes

State Licensed 20-Hour Risk Reduction Course: $360.00

IMPORTANT STUDENT/OFFENDER INFORMATION