Student Registration and Agreement

ANDY'S DRIVER TRAINING INC.

444 WALDEN MEWS SE CALGARY T2X 0T2

Call/Text: 587-966-9910

Email: info@andysdrivertraining.com

STUDENT REGISTRATION AND PAYMENT
The course enrollment date is auto-filled and cannot be changed.

YearMonthDay
Please Select the Course*
How would you like to complete 15 Hours Theory Course. IN-CLASS session occurs once a month. Please confirm the date before registration.*
Student Personal Information*

STUDENT LAST NAME FIRST NAME MIDDLE NAME / INITIAL
Address*

Number, Street, Apartment, PO Box, Rural Route

Street Address Line 2

CityState / Province

Postal / Zip Code
Pickup/Dropoff Address or Notes (If any)
Home, School or Work
Date of Birth*

YearMonthDay
Gender*
Student Phone Number*
Please enter a valid cell phone number.
Student Email*
example@example.com
Driver's License Number*
000000-000
License Issue Date*

YearMonthDay
Parent/Guardian Information (If Student Under 18)

FIRST NAMELAST NAME
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com

Please select your course and pay using your preferred method. Don’t forget — you can choose Afterpay at checkout to split your payment into 4 interest-free instalments!*

Should be Empty:

Payment Methods