College of Lake County
Driver Safety School
Court Referral Registration Form
Immediate Registration Is Required!
111 North Genesee Street, Waukegan, Illinois 60085
Phone (847) 543-2185
wpdi.clcillinois.edu/judicial
Important: Driver Safety classes must be completed
30 days prior to your court supervision date, and you
must present your Certificate of Completion to the court.
Registration Options — Do NOT pay the court.
These instructional classes offered by the College of Lake
County are 4 or 8-hours in length.
To complete registration, pay fee to Driver Safety School.
1. Register By Mail (Preferred Method) Complete this form
and mail to the address above. Personal check, certified
bank check, debit/credit card or money orders are
accepted for payment. Do not send cash.
These classes are designed to improve decision-making
skills, decrease the possibility of future violations, and
reduce the possibility that you or someone else will be
killed or injured in a traffic collision.
DDC-8, DDC ADD, SAM, BCM and LVIP have limited course
availability. Register early to get your choice of class date/time.
Rescheduling Fee
You may reschedule a class up to 48 hours prior to the class
date once at no charge. Each additional rescheduling fee will
be $15.00.
Failure to appear in class without notifying the Driver Safety
School office (847-543-2185) before the class date will result
in a charge of $50.00 to reschedule.
All prices are subject to change.
2. Register in Person – Appear at the address listed above.
Personal check, certified bank check, debit/credit card
or money orders are accepted for payment.
No cash payments are accepted.
3. Register by Fax – Complete form and fax to
(847) 543-2188. Debit or credit card payment only.
4. Register by Phone – Please call (847) 543-2185.
Debit or credit card payment only.
Notice: It is your responsibility to notify the Driver Safety
School if you have not received a notice of class assignment.
Si ud. no quiere que su boleto de infraccion quede sobre su
archivo de manejar y ud. no puede leer o comprendar esta
forma, favor de llamar (847) 543-2185.
Remove and keep top portion for your information. CLC is not responsible for lost, late or undeliverable mail.
REGISTRATION FORM (Complete form in ink. Please print)
Ticket Received in:
Student Information:
Case Number
■ Lake County, Illinois
■ Outside of Lake County, Illinois
■ Out of State
Supervision Date
Last Name
First Name
Middle Initial
Date of Birth
Driver’s License Number
Payment Method:
Check/Money Order:
Make checks payable to Drivers Safety School.
Check #________
Credit Card: (Amount: $_________)
Current Mailing Address:
Number
Street
City
Apt No.
State
(Amount: $_________)
Zip Code
Daytime Phone (Include area code)
Evening Phone (Include area code)
■ VISA
■ Discover
■ MasterCard
■ American Express
Credit Card Number
Expiration Date
Signature
Date
Course Fee Amounts
■ DDC-4 (4-hour Defensive Driving Course) ......................................$50.00
All requests will be accommodated as much as
possible. (Check one box for each question.)
OR
Area you would prefer to attend class:
■ Northeast Lake County (Waukegan)
■ Central Lake County (Grayslake and Round Lake Beach)
■ Southwest Lake County (Lake Barrington)
■ Southeast Lake County (Vernon Hills)
■ Internet - You must be 18 years or older.
■ DDC-4 Internet (Online Defensive Driving Course) ........................$65.00
You must be 18 years or older. (Email address is required.)
■ Not Eligible for Internet per Judge
■ DDC-Alive at 25 (4-hour Teen Course) ..........................................$50.00
■ CLC-BCM Juvenile/Adult (4-hour Behavioral Choice Module) ........$50.00
Saturday and Evenings Only-NOTE: Parents/Guardians MUST Attend
1st Half Hour with Juvenile participants.
Preferred Language:
■ English
■ Spanish
Saturday and Evenings Only - Grayslake Only
Preferred day of class:
■ Weekday ■ Weeknight
■ DDC-8 (8-hour Defensive Driving Course) ......................................$70.00
■ DDC-ADD (8-hour Attitudinal Dynamics) ......................................$95.00
■ Other _______________
■ Saturday
Saturday and Evenings Only - Grayslake Only
Preferred class time: (No Saturday evening classes)
■ 8 a.m.
■ 1 p.m.
■ 6 p.m.
Grayslake Only
Select One:
■ Location is more important to me
■ Time of day is more important to me
■ CLC-SAM (4-hour Substance Abuse Module) ................................$50.00
■ LVIP........................................................................................$50.00
Grayslake Only
No one who is considered alcohol or substance impaired will be admitted.
7/15
Course Offering Locations
Key:
1 Northeast Lake County
Lakeshore Campus, 33 North Genesee Street, Waukegan
2 Central Lake County
Grayslake Campus, 19351 West Washington Street, Grayslake
3 Central Lake County
1792 Nicole Lane, Round Lake Beach
3
1
4 Southwest Lake County
23860 Old Barrington Road, Lake Barrington
2
5 Southeast Lake County
Southlake Campus, 1120 South Milwaukee Avenue, Vernon Hills
All facilities are ADA compliant.
4
Course Hours/Schedule
5
No evening classes are held on Saturday. No one who is considered
alcohol or substance impaired will be admitted.
4-hour course: (Mon.-Sat.)
8 a.m.-12 p.m. (Noon)
1-5 p.m.
(Mon.-Fri. Evening) 6-10 p.m.
If you register for the DDC-4 Internet Course, you will
be notified by mail of your Internet Access Code and
instructions for completion of the online class.
8-hour course: (Mon.-Fri. Evening) 6-10 p.m.
(Sat.)
8 a.m.-5 p.m.
Live Victim Impact Panel:
6:15-8 p.m.
(Check-in at 6 p.m.)
Notice: It is your responsibility to notify
the Driver Safety Program if you have not
received a notice of class assignment.
YOU MUST COMPLETE DRIVER SAFETY SCHOOL
30 DAYS BEFORE THE END OF YOUR COURT
SUPERVISION COMPLETION DATE.