Enrolment In: Enrolment In: DEFENSIVE DRIVER COURSE | LEVEL 2 @ ALTONA – MIDWAY LTD – Friday 06th December 2024

"*" indicates required fields

SECTION A - ENROLMENT OPTIONS

DEFENSIVE DRIVER COURSE | LEVEL 2 COURSE IN ALTONA, VICTORIA*

Price:

COUPON | GIFT CERTIFICATE

If you have a Coupon or Gift Certificate for this course, please enter your Coupon or Gift Certificate code here.

SECTION B - PERSONAL DETAILS

Title

First name*

Enter your first legal given name

Middle Name

Family name (surname)*

Enter your legal family name (surname)

Date of birth*

DD slash MM slash YYYY

Select your date of birth using the calendar to avoid formatting errors

CONTACT DETAILS

If possible, PLEASE provide us with BOTH your home (landline) and mobile numbers. As this course requires the coordination of yourself and a driver trainer, it may become important for our team to contact you should the need arise.

Telephone: Home

Telephone: Mobile*

Your preferred email address*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please provide the physical address of where you usually reside - street number and name, not post office box. Do not provide any temporary address at which you reside for training, work or other purposes. If you are from a rural area, use the address from your state or territory's rural addressing or numbering system as your residential street.

Is your mailing address the same as your residential address?*

YES

Please enter your mailing address below.

Please enter your mailing address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

NOTE: This will be the address our team will send out your Certificate should you choose to have a printed copy sent to you

SECTION C - EMERGENCY CONTACT DETAILS

This course contains practical on-road training, therefore we require the contact details of your preferred emergency contact person. Please ensure that the person you nominate here is aware of your medical hisotry. Who would you like us to contact in the unlikely event of an emergency?

Title

First Name*

Family Name (Surname)*

Telephone: Mobile*

Telephone: Other

Relationship: How this is person related to you?*

SECTION D - DRIVERS LICENCE REQUIREMENTS

PLEASE NOTE:

Students will use their own vehicles during this course. On the day of the course, you must turn up in a road-worthy vehicle that is clean inside and out. Your vehicle cannot have any unrepaired damage.

In the event your vehicle is unroadworthy, damaged, or unclean, you will be excluded from the practical components of this course and will forfeit any fees paid.

Do you hold a current and valid Australian Drivers Licence or Learner Permit?*

YES

Has your Australian Drivers Licence or Learner Permit been recently cancelled or suspended OR is scheduled to be cancelled or suspended?*

YES

If your licence or learner permit has been suspended or cancelled, you cannot enrol into this course. If your driver's licence or learner's permit is pending suspension, please ensure that your licence will still be active prior to attending this course.

IMPORTANT NOTE: Failure to attend this course with a valid, current driver's licence or learner's permit will result in your trainer cancelling this course on the day. If we need to cancel your course due to you not having a valid licence or permit, you will be liable for the full cost of this course. No refunds are issued to participants who attend a defensive driving course without a valid drivers licence!

SECTION E - TERMS AND CONDITIONS & STUDENT DECLARATION

Please take a moment to review our standard enrolment terms and conditions by clicking the following link: Enrolment Terms and Conditions

PLEASE NOTE:

TO SUBMIT THIS ENROLMENT FORM, YOU MUST AGREE TO ALL THE TERMS AND CONDITIONS LISTED BELOW & SIGN YOUR NAME WHEN PROMPTED.

STUDENT DECLARATION*

I declare that the information I have provided, to the best of my knowledge, is true and correct.

I understand the terms and conditions of this written agreement, including the refund procedures. I have understand the fees and refund conditions of my enrolment and agree to be a student of Intelligent Training Solutions Pty Ltd.

I agree to pay all the fees and charges listed on this enrolment form. I understand that if I nominate a third part to make payment for this enrolment, I remain liable for all enrolment fees until such time as the nominated third party has settled the account.

I understand that I must give I.T.S 7-days notice if I cannot attend this course. Should I fail to provide 7-days notice, I understand that I am liable and must pay the FULL course fees. Failure to do so will result in my account being sent to a debt collection agency.

I have made my own enquiries and believe that this training course is suitable for my personal and/or career purposes. I consider that, based on my educational attainment, capabilities, aspirations and interests, this training is appropriate for me.

You must tick all the boxes above to be presented with the 'SUBMIT YOUR ENROLMENT' button.

If you have any concerns about our terms and conditions, please contact our office on 03 5415 0204 during business hours

STUDENT SIGNATURE*

TOTAL ENROLMENT FEE

Phone

This field is for validation purposes and should be left unchanged.