Chinook Driving Academy

Please Enroll me in the following course. * 🛈

Please enroll me in the following classroom session: *

Last Name *

First Name *

Address *

City and Province *

Postal Code *

Home Phone * 🛈

Students Cell Phone * 🛈

Email Address *

Please give us permission to email or Text you. We use these to send you a confirmation email, discuss schedules, send copies of Certificates etc. You may opt out of getting emails or texts at any time.

Chinook Driving Academy has my permission to contact me by email and/or Text Messaging.

*

Licence Information If Applicable

Licence Number

Licence Class

Date of Issue

Approximately how many hours have you driven? *

Date of Birth
yyyy/mm/dd *

Do you attend school?
If so which? *

In Car Lessons

Please check one or more of the following to indicate when you are available for in car lessons. The more information that you can give us the better. Please remember that the more available that you are, the sooner you can complete your course. In-car lessons are usually scheduled once classroom has begun, If you would like to drive sooner, please submit this form and then phone our office at 403-281-8050

Anytime	Days
Afterschool and Evenings	Weekends
Evenings	Other

*

Please Give us any additional information which will help us work out your in-car schedule

Parent(s) or guardian(s) information if applicable and/or emergency contact person

Name 🛈

Address 🛈

City and Province

Postal Code

Home Phone 🛈

Cell Phone (s) * 🛈

Email Address

Please note that we cannot accept visa debit cards on-line at this time.
If you prefer, you may send an E-transfer to cda2@telus.net, Thank you.

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

Security Code 🛈