Client Referral Form

Please fill out the online form below, by filling in each section and clicking NEXT once you have completed each part. All mandatory sections are required. 

Note that sending a referral does not automatically guarantee you a place on our programme. We will assess your referral and get in touch with you once we have reviewed your referral. We also highlight that wait times may apply due to high demand.

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Referrer Contact Details

Client Details

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Health and Safety Requirements

If You Are Sick

Face Masks

We may require you to wear a face mask when attending our programmes. This is not limited to only Government restrictions (if applicable) as we maintain our own health and safety policies and procedures. This may occur during Winter months annually or if we believe that you have symptoms. 

Please note also that you may request a face mask from us at anytime if you prefer to wear one to maintain your own wellbeing

Health & Safety Compliance

Emergency Contact Person

Please note that this person will also be the first point of contact in an emergency.

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Parent/Guardian Details (required for clients under 18 years old only)

Note we only require these details for under 18 years olds being referred to our service

Please provide a second point of contact in case we are unable to reach the primary contact in case of emergency.

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Accidental Damage  

While we have insurance in place to cover accidental damage during lessons, if the client causes an at-fault accident during a lesson, the client will be liable for the excess costs to repair the vehicle. For under 18 year olds, this cost will be met by the parent/guardian listed on this referral. The cost of excess cover ranges between $500-$1500 depending on licence status and age of the student.
For all not-at-fault accidents, there is no cost to the client as fully covered by our insurance.
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Video and Audio Data

For the safety of our clients and staff, we operate in-car cameras during driving lessons which involves the collection of audio and video data. This information maybe used for quality, training, safety and incident investigation. This is a mandatory requirement to participate in training. Please tick to confirm that you agree to this requirement.

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To complete this referral, please hit "Send Referral Now"

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