EmailMe Form - Student Sign Up Form (New Brunswick)

Todays Date *

MM / DD / YYYY

Recommended By

Please use this field if you are an Instructor signing up a student who contacted you directly, or if you are a student who was asked by an Instructor to fill out this form. This assures that student and instructor will be paired together for the training course.

Name *

First MI Last

Date of Birth *

MM / DD / YYYY

Age *

Contact person if applicant is under 16 years of age

First Last

Please provide a parent or guardian contact name if the applicant is under 16 years of age

Email *

Confirm

Address *

Street Address City State / Province / Region Postal / Zip Code

Primary Phone Number *

### - ### - ####

Type of Quad *

ATV (Handlebars)

UTV/Side by Side (Steering Wheel)

Availability *

Weekdays during normal business hours

Weekends only

My schedule is flexible

Specific days and or times

Check all that apply

Other Information *

I require an age appropriate rental ATV ($50.00) for my child under 16 years of age

I own an ATV and am able to use it to take the training

I am a Recreational Rider

I require training for my work (Corporate)

Check all that apply

Please advise us as to the region that you would like to be trained

If Your address is Moncton; however you are spending the summer in Campbellton, we want to be sure that you are directed to a suitable Instructor