Surname - Participant 1

Given Name - Participant 1

Date Of Birth - Participant 1

Drivers Licence Number - Participant 1

Drivers Licence Expiry Date - Participant 1

Surname - Participant 2

Given Name - Participant 2

Date Of Birth - Participant 2

Drivers Licence Number - Participant 2

Drivers Licence Expiry Date - Participant 2

Address

Post Code

Telephone/Mobile Number

Email Address

Caravan Make

Caravan Size

Number Of Axels

Caravan is a 5th wheeler

3rd Party Insurance

Towing Vehicle Make

Insurer Name

Comprehensive Insurance

3rd Party Insurance

Policy Number

Expiry Date

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Terms and Conditions of Use and Indemnity

1. I am eighteen (18) years of age or over.

2. I have a current licence and undertake and agree that this Licence shall be current at the time of my participation in the course.

3. I undertake and agree to ensure that the motor vehicle used by me in the driving course shall be roadworthy and registered pursuant to current Victorian Road Traffic Legislation and that such vehicle is covered by Comprehensive or Third Party Property Only Insurance (refer page 1).

4. I acknowledge and understand that:a. The driving course which I will participate in is potentially hazardousb. Other drivers will be using the course at the same time I amc. My presence on the course may expose me to risk either from an incident caused by me or by other people or by the nature of the activities conducted on the coursed. I will not exceed the speed limits set by the Centre, unless under instruction to do soe. I will comply with all instructions given to me by all officers, employees, contractors, servants or other agents of the Centref. I may be required to drive one of the Centre’s or Instructor’s motor vehicles and that I do so at my own risk and will use all due care and attention when driving the vehicle.

5. I agree to indemnify and keep indemnified the Centre and its officers, employees, contractors, servants and other agents from all costs, actions, suits or demands arising out of any damage that may occur as a result of my negligence or as a result of any breach of the terms of this enrolment forma. To any property owned by me/the participant whilst at the Centre’s premisesb. Any property owned by the Centre including any motor vehicle provided for my use including personal property.

6. I authorize the Centre or its agents to obtain such medical or hospital treatment for me as the Centre may deem necessary whilst I am participating in the driving course or at the Centre and I agree to indemnify and keep indemnified the Centre and its officers, employees, contractors, servants and agents from all expenditure or costs in relation to such medical or hospital treatment together with any other costs or expenditure incurred by any ambulance, police or fire brigade attendance arising out of such treatment. CANCELLATION/REBOOKING POLICY:• Bookings may be transferred to another course provided a minimum of seven

(7) business days’ notice is given.• No refunds will be given for cancellations or transfers made within seven (7) days of the course date. • In the event of booking changes or booking cancellation more than seven (7) days from course date, a $50.00 administration fee will apply.

I have read the terms and conditions

Please fill in this enrolment form at the time of booking