Traffic Safety Association of Macomb County

1Student
2Segment 1 Info
3Segment 2 Info
4Certification
5Payment
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Session Start Time
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Session End Time
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Payment Method
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Important: To complete Segment 1 registration, you will need to upload a copy or clear photo of the student’s birth certificate. Registration is not complete until the form is submitted and payment is received.

Important: To complete Segment 2 registration, you will need the student’s Michigan Level 1 License/permit. Please have a clear photo or copy ready before continuing. Registration is not complete until the form is submitted and payment is received.

Student Name(Required)
Enter Name exactly as it appears on your birth certificate.
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Must be verified by birth certificate: Student must be at least 14 years and 8 months of age by the first day of class.
Student Address(Required)
Parent / Legal Guardian Address(Required)

Accommodations / Medical Condition

1. Does the student require any special accommodations to participate in the classroom phase (i.e., test being read to him/her, interpreter, eating arrangements, etc.)?(Required)
2. Does the student require special accommodations to participate in the behind-the-wheel phase(i.e., adaptive devices, an interpreter, etc.)?(Required)
3. Is the student taking any medications that may affect his/her ability to drive a motor vehicle safely?(Required)
4. Are there any medical conditions/physical impairments that would pose a concern with the student's heind-the-wheel instruction (i.e., epilepsy, asthma, color blindness, hearing loss, physical impairment)?(Required)
5. Is the student's visual acuity at least 20/40 corrected?(Required)
6. In the last six months, has the student had a fainting spell, blackout, seizure, or other uncontrolled loss of consciousness?(Required)
7. In the last six months, has the student had a physical or mental condition which affected his/her ability to drive a motor vehicle safely?(Required)
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    If the answer to any of questions 5-7 is “Yes”, then the Parent/Guardian 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 for a motor vehicle operator’s license under Section 309 of the Michigan Vehicle Code, 1949 PA 300, MCL 257.309.
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    Parent/Guardian Waiver Agreement for Individualized On-The-Road Instruction

    The law requires that TSA provide behind-the-wheel instruction with not less than 2 students in the training vehicle. That requirement may be waived if the parent/legal guardian signs the waiver agreement below, allowing for their son or daughter to be given individual lessons. The student must still complete at least four hours of observation time as a passenger in a driver education training vehicle being driven by another driver education student.
    I allow my student to drive one-on-one with an instructor.(Required)
    By selecting “No” I realize my student’s drives may be canceled or delayed to a later date.
    Clear Signature
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      Certification(Required)
      Notice: This provider is required to be certified by the Secretary of State. If you have any complaint that cannot be settled with the provider, please complete the Driver Education Complaint form found on the Department of State website: www.michigan.gov/teendriver. Completion of driver education does not guarantee qualification for a driver license.
      Clear Signature
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      Clear Signature
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