Student Registration Form

Training for *Class 7 (N License)Class 5 (Full License)

Learner's DL Number *

First Name *As per your Driver's License

Last Name *As per your Driver's License

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Date of Birth *

Date of road test, if booked

Time of road test (not check-in time)

Hours

Minutes

Road Test Location *0 / 10000

Select Lessons Package *

Day & Time available for classes *0 / 10000

Photo/ Video Consent *I gave consent to TASK Driving AcademyI do not agree with the consent termsI hereby irrevocably grant Task Driving Academy, the right to, in whole or in part, reproduce, use, exhibit, display, broadcast, distribute and create derivative works of the photographed and/or filmed images of me – including my image, likeness, and/or voice without compensation, for use in connection with their activities or for promoting, publicizing, or explaining Task Driving Academy or its activities. This grant includes the right to publish such images in PR/promotional materials, such as marketing publications, advertisements, fundraising materials, public affairs releases, broadcast public service advertising (PSAs), recruitment materials, and any other Task Driving Academy - related publications or endeavors. These images may appear in any of the wide variety of formats/media available to Task Driving Academy and that may be available in the future, including but not limited to print, broadcast, videotape, DVD, electronic media, online media, and social media.

Additional Notes