WDS Registration Form

WESTERN DRIVING SCHOOL

Suite 305 Millbrook Mall
Corner Brook, NL

Tel: 709-639-7925

TRAINING REGISTRATION FORM

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 Novice classroom training is done online using the ZOOM platform.

You MUST complete the online portion of Novice classes at least 3 months in advance of your Road Test Eligibility date. We book in vehicle lessons from 30 to 45 days in advance, otherwise you could experience delays.

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.

Did you have a previous permit? *

Yes
No

If "Yes", what was the issue date of your previous permit?

Was your previous permit EXPIRED for more than 2 years?

Yes
No

Do you have any medical conditions that may impact your driving? *

Yes
No

If you answered "Yes" to medical conditions that may impact your driving, please specify.

Do you have any other conditions that may affect your in-vehicle training? *

Yes
No

If you answered "Yes" to other conditions that may affect your in-vehicle training, please specify.

Do you require a translator for your sessions? *

Yes
No

If you answered "Yes" to requiring a translator, please specify the language.

IT IS YOUR RESPONSIBILITY TO SUPPLY YOUR OWN TRANSLATOR

Have you been previously licensed in another province or country? *

Yes
No

If you answered "Yes" to having been previously licensed in another province or country, please attach a copy of that license.

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.

Date *

Verification Code: Visual Verification Image

Enter Verification Code: *

* Required