Student Registration — Driving Zone

Student Information

Who are we teaching?

Last Name*

First Name*

Middle Name(optional)

Gender*

Registration Date

How did you hear about us?*

Street Address*

Apt / Unit(optional)

City*

Province*

Postal Code*

Student Cell*

Student Home Phone*

Student Email*

Licence Information

Required by Alberta Transportation for in-vehicle training.

Student Licence No.*

Cond / End(optional)

Class*

Issuing Province*

Issue Date*

Expiry Date*

Date of Birth*

Course Selection

Pick your course and any add-ons.

Course*

Theory*

Previous Driving Experience*

Car Rental for Road Test ($90)*

Parent / Emergency Contact

Who should we reach if we can’t reach you?

Parent / Emergency Contact Name*

Parent / Emergency Contact Cell Phone*

Weekly Availability

Help us schedule lessons that fit your week.

Monday

Not available

Tuesday

Not available

Wednesday

Not available

Thursday

Not available

Friday

Not available

Saturday

Not available

Sunday

Not available

Special Conditions

Tell us about any medical conditions or other circumstances that may affect your driving lessons.

Any special conditions or requirements?*

Disclaimer & Signature

Type your full name to confirm that you have read and reviewed the terms and conditions.

I have thoroughly reviewed the responsibilities and in this document, and I agree to accept and abide by the rules contained herein.

I have read and agree to the .

Date

Student Signature

Parent / Guardian Signature

Driving Zone Representative Signature

Student Registration & Agreement

Student Information

Licence Information

Course Selection

Parent / Emergency Contact

Weekly Availability

Special Conditions

Disclaimer & Signature

Student Registration & Agreement

Student Information

Licence Information

Course Selection

Parent / Emergency Contact

Weekly Availability

Special Conditions

Disclaimer & Signature