Register for a Course

298b Flaxton Road, Rangiora, NZ

Interested in a course? Contact us below!

Student Name

Phone

If currently employed, where?

What school are you attending? (please answer 'nil' if not currently at school

Date of Birth

Ethnicity

Gender

Area you live in

How did you first hear out about YDOT?

Have you attended YDOT courses previously

Do you have transport arrangements that will ensure you can arrive at course for the scheduled times and dates?

Are there any other commitments that may prevent you from arriving to course at any stage?

Any medical conditions we should know about?

Please note anything else that may impact on your ability to complete the course

Contact Name

Contact Phone Number

Relationship to student

Support Person Name

Email contact for support person/referrer

Support Person's Phone Number

Any further comments:

Thanks for completing details, we will be in touch shortly!