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COURSE REGISTRATION FORM

*To register, please print this form, fill and mail it with deposit to:
CIRCUIT Driving School, 1585 Tenth Line Rd, Unit 8, Ottawa, ON K1E 3E8

(Please print)

Your Name____________________________________
Date of Birth ___/___/___ (yy/mm/dd)

Sex (CIRCLE ONE): Male / Female

Address____________________________________________________________

City__________________________ Postal Code ______________________________

Home Phone #___________________ Work Phone # ___________________________

Drivers License #_____________________________ Date of Issue ___/___/___ (yy/mm/dd)

Course to be taken with (CIRCLE ONE)   Automatic      Auto manual

Course Date: ___/___/___   ___/___/___   ___/___/___    ___/___/___ (yy/mm/dd)

Signature __________________________________

Please Note: Should the student have to leave the program, a charge of $40.00 per hour of driving time used will be deducted from the course fee, and an additional $10 will be deducted for every hour of in-class training. You have 1 year to complete the full course.

* Fifty ($50.00) dollars deposit must accompany your registration form. This amount will be deducted from the total cost of the course.


Contact us:
Off: (613) 824-2277 Email: circuit90@hotmail.com

© Designed and maintained by MIW, last updated: Feb. 21st, 2011