First Name
Last Name
Date of Birth
Phone Number
Residential Address
City/Suburb
State/Province
Postal/Zip Code
Do you have any prior driving experience?
If yes, please specify.
Type of vehicle(s) driven.
Duration of experience.
Where did you gain this experience? (e.g., private practice, another driving school.)
Do you currently hold a learner’s permit or driver’s license?
Learner’s Permit
Provisional License
Full Driver’s License
None
Have you ever taken a driving course before?
If yes, please provide details.
What type of driving course are you interested in?
Beginner’s Course
Refresher Course
Defensive Driving Course
Advanced Driving Techniques
Other:
What type of vehicle do you want to learn to drive?
Manual Transmission
Automatic Transmission
Motorcycle
Commercial Vehicle (e.g., truck, bus)
Other:
What is your primary goal for taking this course?
To obtain a driver’s license
To improve driving skills
To gain confidence on the road
To prepare for a driving test
Other:
What is your preferred schedule for driving lessons?
Weekdays
Weekends
Evenings
Flexible
What is your preferred time(s) for the lesson?
First Choice
Second Choice
Third Choice
How soon would you like to start the course?
Immediately
Within 1-2 weeks
Within 1 month
Not sure
How soon would you like to start the course?
5-10 hours
10-20 hours
20+ hours
Not sure
Do you have any medical conditions or disabilities that may affect your ability to drive?
If yes, please provide details.
Are you comfortable with driving in various conditions (e.g., heavy traffic, highways, night driving)?
Yes
No
Not sure
How did you hear about our driving school?
Referral
Online Search
Social Media
Advertisement
Website
Do you have any questions or concerns about the course?
I confirm that the information provided above is accurate to the best of my knowledge.
Customer Signature
Thank you for completing this form. We look forward to helping you achieve your driving goals!
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