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severe difficulty breathing (e.g., struggling for each breath, speaking in single words)
severe chest pain
having a very hard time waking up
feeling confused
lost consciousness
unable to lie down due to shortness of breath
I have none of the symptoms listed above


Disclaimer	All information collected by Western Driving School will remain Personal & Confidential. Some information such as names and courses taken may be used to advocate/communicate on your behalf with Government Offices such as Motor Registration Division NL and Members of House of Assembly.
Do you "Agree" or "Disagree" to this disclaimer? * Agree Disagree
Training Requested *
For all packages of the Novice Driver Education Course, a $200.00 deposit is required when your class start date is confirmed. All other training courses require full payment before first session. Payment is to be made by eTransfer to the following email: [email protected]
If applying for the ADT - Addictions Course attach a copy of your drivers abstract.
If you are registering for our Novice training specify your preferred class start date as per our current schedule.
All classroom training is done online using the ZOOM platform.
If you are registering for our Novice training specify the date your permit was issued.
If you are registering for our Novice training specify your preferred location for in car lessons and road test.
Student's Name *
Student's E-mail Address: *
Student's Telephone Number *
Student's Permit Number (New Drivers Only)
Attach copy of student's permit if possible.
Do you have any medical conditions that may impact your driving? * Yes No
If you answered "Yes" to any medical conditions, please specify.
THIS SECTION IS REQUIRED IF STUDENT IS UNDER THE AGE OF 19 YEARS
Parent's Name
Parent's Email Address
Parent's Telephone Number
Parent's Drivers Licence Number
Attach a copy of parent's drivers licence if possible.
THIS SECTION IS REQUIRED IN COMPLIANCE WITH OUR COVID-19 PROCEDURES AND PROTOCOLS
Are you experiencing any of the following? * severe difficulty breathing (e.g., struggling for each breath, speaking in single words) severe chest pain having a very hard time waking up feeling confused lost consciousness unable to lie down due to shortness of breath I have none of the symptoms listed above
In the past 30 days have you had close contact with someone who is confirmed as having COVID-19? *
A close contact is defined as a person who: provided care for the individual, including healthcare workers, family members or other caregivers, or who had other similar close physical contact without consistent and appropriate use of personal protective equipment OR who lived with or otherwise had close prolonged contact (within 2 meters) with the person while they were infectious OR had direct contact with infectious bodily fluids of the person (e.g. was coughed or sneezed on) while not wearing recommended personal protective equipment
Do you have two or more of the following symptoms (new or worsening): * fever (or signs of a fever such as chills, sweats, muscle aches and light-headedness) cough headache sore throat painful swallowing runny nose unexplained loss of appetite diarrhea loss of sense of smell or taste are you experiencing small red or purple spots on your hands and/or feet? I have none of the symptoms listed above
By checking this box I certify that I have read and understood Western Driving Schools's COVID-19 protocols and policies. *
Date *
Verification Code:
Enter Verification Code: *


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