PRIVATE DRIVING LESSONS

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.

I accept this disclaimer

I reject this disclaimer

Specify the Date Your Permit was Issued: *

MM

DD

YYYY

Student Name *

First Name

Last Name

Student Telephone Number *

(###)

###

####

Did you have a previous permit? *

Yes

No

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

Yes

No

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

Yes

No

Do you require a translator for your sessions? *

IT IS YOUR RESPONSIBILITY TO SUPPLY YOUR OWN TRANSLATOR

Yes

No

Have you been previously licensed in another country? *

Yes

No

Not applicable

Is the student under the age of 19 years? *

Yes

No

I have read and agree to the Terms and Conditions *

Yes