Archers Blue Car Driving School Classroom Only Registration

1
Archer's Blue Car Driving School

Classroom Only Registration Form
2
Student Name
First Name
Middle Name
Last Name
3
Parent or Guardian Name (if Student is under 18 years of age):
First Name
Last Name
4
Registration Date
Date
Month
Day
Year
5
Student Information

The information on this form is collected in accordance with Alberta's Personal Information Protection Act (PIPA). Please see our website at www.archersbluecar.ca for our full privacy policy.
6
Home Address
Street Address
Street Address Line 2
City
Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Student's Phone
Area Code
Phone Number
8
Phone is my:
Home
Cell
Work
Other
9
Contact E-mail 1
10
Contact E-mail 2
11
Year of Birth
Full DOB will be obtained at first lesson.
12
These classrooms options are recognized by Alberta Transportation and a classroom completion certificate will issued after successful completion. If the student wishes to enroll for the Insurance Certificate Course within 2 years, they do not have to redo the classroom portion of the course.
13
Classroom Options:
In person 15 Hours Classroom Session at NAIT $75
Online 15 hours self-paced course $115
14
For In-Person Classroom, please select classroom dates
03-04 October 2020
15
I Plan to pay by:
Cash, debit card, Interac E-Transfer, cheque.
Visa, Master Card, PayPal. (3% will be added to the total price)
16
Total price, GST included:
17
Please make cheques/money orders payable to Archer's Blue Car Driving School Ltd.; Online banking E-transfer payments may be sent to: payments@archersbluecar.ca Include Student's First and Last Name.
18
PLEASE add office@archersbluecar.ca to your email senders list, otherwise the confirmation email we send may go to your junkmail folder. If you register online and have not received a confirmation email from us within 24 hours, please check your junkmail folder and/or contact us by email at office@archersbluecar.ca or by phone/text at (587) 990-2583.
19
Do you have any questions or comments?
20
* This field is required.
21
Tags
[object Object]
Should be Empty: