FREEDOM TO DRIVE INC.
BLUE QUILL DRIVER TRAINING CENTER
382 SADDLEBACK ROAD
EDMONTON, ALBERTA
CANADA T6J 4R7
Tel: 780-437-4833
Fax: 780-437-4841
Toll-Free: 866-592-4833

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Please complete the following form and click Submit.
We will contact you as soon as possible regarding your request.

First Name *
Middle Name
Last Name *
Street Address
Apt. #
City
Province
Postal Code
E-mail Address *
Home Phone
Cell Phone
Work Phone
Date of Birth
Sex
M   
F   
Any disability of which we should be aware?
Emergency Contact:
Emergency Contact Phone:
Learners License #
GDL Expiry Date
Date Issued
Code or Condition
MVID (# under bar code on the front of licence)
Pick up address for lessons
How did you find about Freedom to Drive?
Yellowpages   
Found on the Web   
Saw one of our cars   
Referred by family or friend   
Posters or other advertisement   
Can Pages   
Other
Driving Instruction Program or Package in which I would like to register:
Critical Skills Package for New Drivers
Yes   
Basic Package for Insurance Certificate
Yes   
Premium Packages
A   
B   
C   
D   
E   
F   
G   
Six Hour Insurance Reduction Package
Yes   
Brush-Ups for Senior Citizens
Yes   
Standard Transmission
Yes   
Adaptive Controls for Persons with Physical Disabilities
If yes, please indicate program required:
Brush Up or Other Program
If yes, please indicate program required:
Edmonton High School that I am attending (optional)
Grade I am in (optional)
Defensive Driving Course For Demerit Reduction
Yes   

* Required to submit this form





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freedomtodrive@shaw.ca

Edmonton, AB

Tel: (780) 437- 4833
(780)  4DRIVE3
Fax: (780) 437- 4841








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