Proposed Course Date
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Your Name (full name needed for certificate)
Attending with
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Company Group
School Group
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(if applicable) Name of Company or School
Email (the one you will log-on with for e-learning)
Your Licence Number
Your Phone Number
Phone Number for Emergency Contact
CANCELLATION POLICY
REFUND OF THE E-LEARNING MODULES IS NOT POSSIBLE ONCE LOG-IN HAS COMMENCED. FOR THE PRACTICAL COURSE. YOUR BOOKING RESERVES A PLACE ON THE SESSION, WHICH HAS LIMITED NUMBERS. LIKE A MUSIC CONCERT, FAILURE TO ATTEND, CONSUMES YOUR POSITION. NO REFUND OR REBOOKING IS AVAILABLE FOR NON-ATTENDANCE . IF UNWELL A REBOOKING IS AVAILABLE WITH A DOCTORS CERTIFICATE, CANCELLATION AND REFUND (OF PRACTICAL COURSE FEE) IS AVAILABLE PROVIDED MORE THAN 48 HOURS NOTICE IS PROVIDED BEFORE THE COURSE START. DISCOUNTED GROUP PRICING RELIES ON THE CORRECT NUMBER OF ENROLMENTS BEING RECEIVED. IF PARTICIPANTS DROP OUT FROM A GROUP, ATTENDEES WILL NEED TO PAY MORE.
I have read the above conditions and agree
Yes
No
RELEASE & INDEMNITY
TO SAFE DRIVE TRAINING IN CONSIDERATION OF SAFE DRIVE TRAINING AGREEING TO PROVIDE PRACTICAL INSTRUCTION IN THE TECHNIQUES OF DEFENSIVE DRIVER TRAINING, I, THE UNDER SIGNED, SEVERALLY FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, DO HEREBY;
1. Release and discharge Safe Drive Training and its principals, it's employees, agents, sponsors and servants from all actions, suits, causes of actions and/or suits, claims and/or demands whatsoever that might at any time hereafter arise against Safe Drive Training and its principals, its employees, agents or servants for, or in respect of, any death or injury to myself or any person or company howsoever arising, or any loss or damage to property howsoever arising or occurring in the course of or in connection with practical defensive driver training.
2. Agree to keep Safe Drive Training and its principals, its employees, agents, sponsors and servants indemnified from, and against, all actions, suits, causes or action, claims and demands whatsoever, which I or any person or company may at any time hereafter have against Safe Drive Training and its principals, its employees, agents or servants for, or in respect of, any death or injury to myself or any person, or any loss or damage to property arising in the course of, or in connection with, the participation by me in such practical defensive driver training.
3. Acknowledge that I have read this entire enrolment document and understand the document and its legal consequences.
I have read the above and agree
Yes
No
GIFT VOUCHER
Do you want a Gift Voucher emailed?
Yes
No
Email Voucher to (if different from above)
Comments or Notes
PROGRAM BEING BOOKED
Safe Drive (Defensive) E-Learning only $66
Yes
Defensive practical course with E-Learning (South-east Qld venue) $253
Yes
Defensive practical course with E-Learning (Regional venue) $297
Yes
Defensive + Skidpan + E-Learning $385
Yes
Defensive Group discounted format (P.O.A.)
Yes
Safe Operation of 4WD Vehicles (e-learning) $55
Yes
Safe Drive Defensive E-learning + Safe Operation of 4WD Vehicle E-Learning $110
Yes
4WD Off-road Training (with e-learning) using SDT 4WD vehicles $330
Yes
4WD Off-road Training (with e-learning) using own 4WD vehicle $275
Yes
4WD Off-road Training Group Program/Format
Yes
Safe Driving Trailers (e-learning) $44
Yes
Advanced Car Control (S1 + S2) $330 own car
Yes
(S1) Accident Avoidance Session $165 own car
Yes
Skid Pan Experience using 86 and BT50 $209
Yes
Skid Pan Experience using Nissan Z (manual) $242
Yes
Skid Pan Experience using own vehicle $165
Yes
If using own vehicle, what MAKE/MODEL?
Do you want the optional $22 Safety Pack?
Yes
No
PAYMENT METHOD
This is being paid for by?
Please Select
Direct Deposit
Visa or Mastercard
You will phone office
Please phone me
Cheque
Company PO
Please Select
SAFE DRIVE TRAINING (AUST) PTY LTD
BSB Number: 124 026
Account Number: 11 087 048
Bank: BANK OF QUEENSLAND
Branch: DAISY HILL
PLEASE NOTE: We do not store credit card numbers in a database or on a file server.
Credit Card Number (Visa or Mastercard)
Name on Card
Expiry
CCV
AMOUNT BEING PAID = $
Comments/Feedback
CHECK THE CANCELLATION & INDEMITY CLAUSES ARE MARKED YES
Yes
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