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Safer Drivers Course Registration

Sunday, 30 June 2024 at 9:00AM

Club Burwood RSL, 96 Shaftesbury Rd, Burwood

Student Enrolment Form

I understand that I cannot book my Module 2 Coaching through this booking system NOR by contacting the team at Learn Drive Survive. I understand that I will be advised of my Module 2 time closer to the course date.

Module 2 Coaching is on the same day where possible.

Licence No. (8 Digits):

Licence Expiry:

Card No. (10 Digits ):

Date of Birth (must be under 25):

Suburb of Residence:

Gender:

Do you have your Driving Test booked?

If Yes, what date is your driving test booked?:

Are you Completing the Course with a Friend?

Who is the other student you would prefer to complete Module 2 with?:

Driving Experience - You MUST have 50+ actual driving hours

Driving Hours = actual hours driven NOT, Bonus hours

Actual Driving Hours Logged:

Do you have a current Driving Instructor?

Name:

Medical Conditions

Do you have any medical conditions that may affect your driving?

Our team can best assist where this question is answered truthfully

If Yes, please provide additional information:

Do you have a Centrelink Healthcare or Pension Card?:

If YES, please complete the online concession form

learndrivesurvivesdc.com.au/complete-the-safer-driver-course-for-free

I have read and agree to the Privacy Statement:

I have read and agree to the Cancellation, Re-booking & Non-attendance Policy:

I have read and agree to the Learn Drive Survive Terms and Conditions:

Safer Drivers Course Registration

Student Enrolment Form

Module 2 Coaching is on the same day where possible.

Do you have your Driving Test booked?

Are you Completing the Course with a Friend?

Driving Experience - You MUST have 50+ actual driving hours

Driving Hours = actual hours driven NOT, Bonus hours

Do you have a current Driving Instructor?

Medical Conditions

If YES, please complete the online concession form

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