Circuit Driving School -- Registration Form

	COURSE REGISTRATION FORM
To register, please print this form, fill and mail it with deposit to: CIRCUIT Driving School*, 1585 Tenth Line Rd, Unit 8, Ottawa, ON K1E 3E8

(Please print)

Your Name____________________________________Date of Birth ___/___/___ (yy/mm/dd)

Sex (CIRCLE ONE): Male / Female

Address____________________________________________________________

City__________________________ Postal Code ______________________________

Home Phone #___________________ Work Phone # ___________________________

Drivers License #_____________________________ Date of Issue ___/___/___ (yy/mm/dd)

Course to be taken with (CIRCLE ONE) Automatic Auto manual

Course Date: ___/___/___ ___/___/___ ___/___/___ ___/___/___ (yy/mm/dd)

Signature __________________________________

Please Note: Should the student have to leave the program, a charge of $40.00 per hour of driving time used will be deducted from the course fee, and an additional $10 will be deducted for every hour of in-class training. You have 1 year to complete the full course.

* Fifty ($50.00) dollars deposit must accompany your registration form. This amount will be deducted from the total cost of the course.

Contact us: Off: (613) 824-2277 Email: circuit90@hotmail.com