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Enrolment Form
Type of Driving Training.*
Simulator Training
Automatic Training
Manual Training
student's full name.*
Email Address.*
Phone.*
are you the student or legal guardian?*
Are you...
Legal Guardian
Student - Under 18 years old
Student - Over 18 years old
STUDENT DOB.*
If you are under 18, you must have your parent or guardian review this form and complete this section before submitting.
STUDENT current license level.*
NZ Learners
NZ Restricted
NZ Full Licence
Other
Driver License #.*
License Issue Date*
Version #*
STUDENT Lesson Availability.*
Let us know what time and days you're available for lessons?
License test date (if applicable)
If you've booked your driving test let us know?
Describe Current Driving Experience.*
Home address.*
Training Location.*
Palmerston North
Fielding
Canterbury
Other (please specify)
Vaccination status*
Choose from the dropdown
Current Single Vaccinated
Current Double Vaccinated
Current Double Vaccinated with Booster
Unvaccinated
I have read and accept the Terms & Conditions in the Excellence Driving Academy Website for the following policies:
- The Vehicle damage waiver
- The Covid 19 Management
- The acceptance of lessons & cancellation
- Payment of Invoices & Outstanding accounts
I will advise Excellence Driving Academy as soon as possible if I have any COVID symptoms or have been in contact with anyone known to be COVID 19 positive. I will not attend lessons if I have been at a recent location of interest (listed on the Dept of Health website)
Driver Liability Declaration
I declare that the details recorded above are correct and that I am responsible for any traffic infringement that may occur during any assessment/lesson(s).
Waiver
If a vehicle I provide is used to complete the in-car session(s) then, while the tutor will endeavour to take all necessary professional care, I understand that responsibility for any damage sustained to/by the vehicle or any third party rests solely with me. I acknowledge and agree that neither the tutor nor Excellence Driving Academy will be responsible for vehicle damage sustained in assessment/lessons.
I accept the
terms and conditions in the Excellence Driving Academy website
Thank you! Your submission has been received!
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