Proposed Course Date
Your Name (full name needed for certificate)
(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
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
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
Do you want a Gift Voucher emailed?
Email Voucher to (if different from above)
Comments or Notes
PROGRAM BEING BOOKED
Safe Drive (Defensive) E-Learning only $66
Defensive practical course with E-Learning (South-east Qld venue) $253
Defensive practical course with E-Learning (Regional venue) $297
Defensive + Skidpan + E-Learning $385
Defensive Group discounted format (P.O.A.)
Safe Operation of 4WD Vehicles (e-learning) $55
Safe Drive (Defensive) E-learning + Safe Operation of 4WD Vehicle E-Learning $110
4WD Off-road Training (with e-learning) using SDT 4WD vehicles $330
4WD Off-road Training (with e-learning) using own 4WD vehicles $275
4WD Off-road Training Group Program/Format
Safe Driving Trailers (e-learning) $44
Advanced Car Control (S1 + S2) $330 own car
(S1) Accident Avoidance Session $176 own car
Skid Pan Experience using SDT vehicles $209
Skid Pan Experience using own vehicle $165
If using own vehicle, what MAKE/MODEL?
Do you want the optional $22 Safety Pack?
This is being paid for by?
Visa or Mastercard
You will phone office
Please phone me
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
AMOUNT BEING PAID = $
CHECK THE CANCELLATION & INDEMITY CLAUSES ARE MARKED YES
CLICK SUBMIT TO SEND FORM TO SDT
when you press SUBMIT this form will become an email with the data entered will be coded into the email message