Behind the Wheel Driver Education

BEHIND THE WHEEL DRIVER EDUCATION

PHONE: 0427951600

Safer Drivers Course Participant Information

RMS Privacy Statement

You understand that Behind The Wheel Driver Education will disclose your personal information to Roads and Maritime Services (RMS) and that it may be used by RMS for the purposes of:

·  Verifying your successful completion of the Course; and/or

·  Contacting you to discuss the feedback on the Course.

Otherwise RMS will not use or disclose your personal information without your consent unless authorised by Law. Your personal information will be held by RMS at 101 Miller Street, North Sydney, NSW and you can contact RMS to request to access or correct it.

Course Date:

Personal Information

Full Name
Date of Birth
Address / Post Code
Telephone / Home: (02) / Mobile:
Licence №
(not card number) / Expiry Date
Email
Total Log
Book Hours / № of Structured Lessons
Emergency Contact / NAME: / TELEPHONE:
DIETARY &
MEDICAL INFO: / ACTION
REQUIRED:

Terms & Conditions

Ø  You must give us at least seven (7) days notice to cancel or re-schedule your booking.
Ø  If less than seven (7) days notice there is no refund.
Ø  Non Attendance - No refund given.
Ø  Late arrivals may not be admitted to the Course.
Ø  Payment is required at time of booking. (Invoice with EFT details will be provided)

I acknowledge I have read and understand the RMS Privacy Statement and

BEHIND THE WHEEL DRIVER EDUCATION Terms & Conditions, and I accept these terms and conditions.

Signature: ______

Date: ______

If scanning, please sign & date.

If completing on-line, leave blank, we will print / sign on the course day.

BEHIND THE WHEEL DRIVER EDUCATION

2 MOUNT VIEW PARADE TUNCURRY NSW 2428 and/or PO Box 537 ROUND CORNER NSW 2158

www.behindthewheel.net.au

PHONE: 0427951600 EMAIL: