55 - TheDrivingSchool.ca 629-STOP (7867)

___TANK YOU FOR SIGNING UP WITH THEDRIVINGSCHOOL.CA
PLEASE FILL OUT THE FORM BELLOW.
AFTER YOU SUBMIT THE FORM, YOU WILL BE DIRECTED TO A NEW PAGE WHERE YOU WILL FIND AN INFORMATION PACKAGE FOR YOU TO PRINT.
(CONTACT ME IF YOU ARE NOT DIRECTED TO THE INFORMATION PACKAGE.)
My phone is on most of the time, call me if you have any questions or concerns.

To keep our costs low and to be able to offer an affordable course, we do NOT accept credit cards.

TB 55: APRIL 14-15 & 21-22, 2012

STUDENT'S NAME *

First

Last

DRIVERS LICENCE # WITH DATE OF ISSUE AND EXPIRATION. OR DATE THEY WILL RECEIVE IT *

DATE OF BIRTH, AGE AND SEX AND WHAT HIGH SCHOOL THEY ATTEND *

NAME OF PARENTS *

COMPLETE ADDRESS INCLUDING THE POSTAL CODE *

HOME PHONE *

STUDENT'S CELL PHONE NUMBER *

EMERGENCY CONTACT PERSON AND PHONE NUMBER *

PLEASE LIST ANY MEDICAL, HEALTH CONDITIONS OR MEDICATION THAT MAY AFFECT YOUR DRIVING. ALSO, LIST ANY RELATED DRIVING CONCERNS. *

NAME AND RELATIONSHIP OF THE PERSON FILLING OUT THIS FORM FOR THE STUDENT. YOU MUST BE 18 YEARS OLD OR OLDER TO SUBMIT THIS FORM. *

I WILL PRINT AND READ THE INFORMATION PACKAGE AND ENSURE THAT THE STUDENT WILL ALSO READ THE INFORMATION PACKAGE. I ALSO UNDERSTAND THAT THE SEAT WILL NOT BE SECURED UNTIL THEDRIVINGSCHOOL.CA RECEIVES THE DEPOSIT AS STATED IN THE INFORMATION PACKAGE. THE STUDENT/GUARDIAN GIVES PERMISSION TO FORWARD MY PERSONAL STUDENT RECORD INFORMATION TO THE M.T.O., THE INSURANCE BUREAU OF CANADA OR THE COURSE INSPECTOR PERTAINNING TO HIS/HER ATTENDANCE AT THIS MINISTRY-APPROVED BEGINNER DRIVER EDUCATION COURSE. *

YES NO

BY CLICKING YES TO THIS FORM, I GIVE APPROVAL FOR MY SON/DAUGHTER TO TAKE THE DRIVER INSTRUCTION COURSE AND I WILL FOLLOW THE INSTRUCTIONS IN THE INFORMATION PACKAGE TO SECURE A SEAT. I UNDERSTAND THAT WWW.THEDRIVINGSCHOOL.CA WILL TEACH TO IT'S HIGHEST STANDARDS AND I WILL NOT HOLD www.THEDRIVINGSCHOOL.ca RESPONSIBLE IN THE EVENT OF ANY FUTURE INCIDENT. I ALSO UNDERSTAND AND ACCEPT THAT THERE WILL BE AN IN-CAR CAMERA FOR EDUCATIONAL REASONS AND THE STUDENT IS REQUIRED TO BRING A SD MEMORY CARD TO EVERY LESSON. *

YES NO

DEPOSIT WILL BE SENT BY: *

E TRANSFER (SECURES YOUR SEAT IMMEDIATELY) IT'S IN THE MAIL

EMAIL: ENSURE IT'S CORRECT *

COMMENTS, QUESTIONS OR CONCERNS: *