Apple Valley Driving Schools 30 Highland Avenue, Acadia Univserity Student Union building, Office 628, Wolfville, NS, B4P 1C4 542-4422 Fax: 902-542-1144 Email: info@applevalleydriving.ca

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Date of Birth:	DAY 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MONTH JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YEAR 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
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NS Class 7L Learner's Already: No Yes Issue / Renewal Date: DAY 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MONTH JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YEAR 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Master (File) Number:	Your Driver's License Number
Parent(s) Name:	If applicable
Road Test Payment made to Access NS Already: No Yes Receipt #:
* Note – when paying for your Road Test at Access NS, please do NOT schedule your test, since Apple Valley Driving will do that, based on car and instructor bookings, and student readiness.
Do you have access to a car at home or practice? No Yes standard auto
Have you been driving? Yes If so, how much and what type of driving? Barriers to driving?
Medications:
Are you taking any medications which may affect your abilities when driving? No Yes If so, please indicate:
Height:
Glasses / contacts for driving? No Yes
NOTES:
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Work (if applicable):
Sports, Teams, Music, Drama, other (if applicable):
PAYMENT OPTIONS: The 25/10 Program includes 25 classroom hours at Acadia University (including the Canada Safety Council Defensive Driving Course), plus 10 in-car lesson hours (pick-up and drop-off at home/school/work, in the urban area), plus one use of our car for the Kentville road test; the program price is $660 (including HST). Payment may be made in three installments ($220 now, $220 on or before first in-car lesson and $220.00 on or before fifth in-car lesson hour); or two installments ($330 now and $330 on or before fifth in-car lesson hour).
PLEASE SELECT PAYMENT METHOD: Check One: Visa MasterCard Debit / Cash (please book appointment)
* For debit or cash payments, please book appointment (542-4422) to come to office. Cheque or money order may be mailed to: Apple Valley Driving School, c/o Acadia University, ASU Box # 6580, Wolfville, NS, B4P 2R5
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Driving Training School Licence # 854802766 NS0001

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Good driving is NO accident!