Student Registration Form

Full Name

Please enter your full name.

This field is required.

Date of Birth (MM/DD/YYYY)

This field is required.

Address

City

This field is required.

Postal Code

This field is required.

Student Email

This field is required.

Student Cell Phone

This field is required.

Licence Number

This field is required.

Licence Expiry Date (MM/DD/YYYY)

This field is required.

Previous Driving Experience (if any)

Parent/Guardian Information

Parent/Guardian Name (if under 18)

This field is required.

Parent/Guardian Email

This field is required.

Parent/Guardian Cell Phone

This field is required.

Emergency Contact

Name

This field is required.

Phone number

This field is required.

Medical Information

Explain any medical condition that the instructor must be aware of:

Payment Information (Payment Method)

Down Payment

At Start of In-Class

Balance Owing

Terms and Conditions

1- Payment must be made before the In-Car lessons begin. The payment is made through e-transfer. We do no accept cash.
2- 24 hours notice is required for cancellation or rescheduling otherwise the instructor will charge $70 for a missed lesson.
3- Lesson package must be completed within the 12months period.
4- Valid drivers license must be presented at each lesson if not the instructor has the right to cancel the lesson and the student will be charged for a missed lesson.
5- Unsafe behavior may result in lesson termination without a refund.
6- Use of vehicle for the road test is subject to availability and approval by the instructor.
7- Refunds, if applicable, will be calculated after deducting completed lessons. No refunds for completed lessons.
8- The school is not responsible for lost belongings.
9- Drive and lead driving school is not responsible for road test cancellations made be DriveTest or due to weather or unforeseen circumstances.

Declaration

I confirm that the information provided is accurate and I agree to the terms and conditions listed above.

Student Name

This field is required.

Date (MM/DD/YYYY)

This field is required.

Contact Information

Drive and lead driving school
226-234-7989
www.driveandlead.com
driveandlead@gmail.com