Chinook Driving Academy

Please Enroll me In the Following Classroom Session: *

Please Enroll me in the following course *

Last Name *

First Name* *

Middle Name if applicable *

Address *

City and Province *

Postal Code *

Home Phone *

Student Cell Phone *

Email Address *

Chinook Driving Academy has my permission to contact me by email and/ or text message

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 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 you are, the sooner you are able to complete the course. Our In-car lessons are usually scheduled once the classroom has begun, If you would like to

drive sooner, please submit this form and then phone our office at 403-281-8050.

*

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

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

Name *

Address *

Email Address *

Postal Code *

Home Phone *

Email Address *

Cell Phone (s) *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Security Code *

*We also accept Debit Mastercard as well as Debit Visa Cards.

Anytime	Afterschool And Evenings
Evenings	Days
Weekends	Other