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A.E. Peacock Collegiate - Driver's Education
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* Indicates required question
School Name
*
A.E. Peacock Collegiate
Home School
Other
What in-class session would you like to register for?
*
after school
lunch
SGI Customer Number
Please go to the office to get the form to take to an SGI insurance facility in Moose Jaw to receive an SGI customer number and set up a MYSGI account.
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Student Email Address
*
Your answer
Student Cell number
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian's Cell Phone Number
*
Your answer
Home Address
*
Your answer
City
*
Your answer
Postal Code
*
Your answer
Please identify any medical concerns or allergies
*
Your answer
Have you taken Driver Education classes before?
*
yes
no
If yes, how many hours in-class and in-car have you completed
Your answer
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