Thank you for your interest in our driving courses! Please fill out the form below to help us determine the best course for your needs. We will get back to you shortly to discuss your options and answer any questions you may have.
First Name
Last Name
Phone Number
Date of Birth
Street Address
City/Suburb
State/Province
Postal/Zip Code
Preferred Contact Method
Do you have a current driver's license?
If yes, what type of license do you hold? (Learner / Provisional / Full)
Learner
Provisional
Full
If yes, which state/territory issued your license?
If yes, how long have you held your current license?
Have you had any previous driving lessons?
If yes, approximately how many hours of professional instruction have you received?
Do you have access to a vehicle for practice outside of lessons?
If yes, what type of vehicle is it?
Automatic
Manual
Are you currently learning to drive in an automatic or manual vehicle?
Automatic
Manual
Not applicable
What type of driving course are you interested in?
Beginner Lessons (No prior experience)
Refresher Lessons (Some prior experience, needing to improve skills)
Test Preparation (Preparing for driving test)
Specific Skill Development (e.g., parking, motorway driving, night driving)
Other:
What are your primary goals for taking driving lessons?
Obtain my driver's license
Improve my driving skills and confidence
Learn specific driving techniques
Become a safer driver
Other:
What days are you generally available for lessons?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What times are you generally available for lessons?
First Choice
Second Choice
Third Choice
Are there any specific areas you would like to focus on during your lessons? (e.g., city driving, parallel parking, etc.)
Do you have any specific concerns or anxieties about driving? (e.g., fear of traffic, nervousness about the driving test, etc.)
Do you have any physical or learning disabilities that may require special accommodations during lessons? (If yes, please provide details – this information will be kept confidential.)
Do you have a preference for learning in a specific type of vehicle? (e.g., small car, SUV.)
Do you require lessons in a dual-control vehicle?
Is there anything else you would like us to know?
I confirm that the information provided in this form is true and 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!