My Driving Coach LLC - Client Intake Form
Please complete this form to help us personalize your driving lessons.  We look forward to coaching you - one mile at a time!
Sign in to Google to save your progress. Learn more
Client Information
Full Name
Phone Number
Email Address
Preferred Contact Method
How many hours of driving experience do you have?
What are your biggest driving challenges?
What days/ times work best for your lessons
How did you hear about My Driving Coach LLC?
Clear selection
My Driving Coach LLC Terms and Conditions - Please Read

Terms & Conditions

1. Eligibility

Clients must have a valid learner’s permit or driver’s license to participate in on-road lessons.

Clients under 18 years of age must have parental or guardian consent.

2. Lesson Expectations

Clients must arrive on time for scheduled lessons. A 10-minute grace period applies before cancellation.

Clients must be sober, alert, and fit to drive. If the instructor suspects impairment, the lesson will be canceled with no refund.

Clients must follow all traffic laws and instructor guidance for safety.

3. Payment & Cancellation Policy

Payment must be made prior to or at the start of each session.

Cancellations require at least 24-hour notice to avoid a cancellation fee.

No-shows or last-minute cancellations may result in loss of lesson credit.

4. Liability & Waiver

My Driving Coach LLC is not responsible for any tickets, fines, accidents, or damages resulting from a client’s driving actions.

Clients agree to participate at their own risk and acknowledge that driving instruction does not guarantee passing a driving test or avoidance of accidents.

5. Dash Cam Usage

For safety and instructional purposes, a dash cam may be used in the vehicle during driving lessons.

The dash cam will record video footage of the lesson to help with driver assessment and improve instructional feedback.

Video recordings will not be used for any purpose other than driving instruction unless explicit written consent is provided by the client.

The recordings will not be shared, sold, or distributed without the client’s prior written approval.

6. Data Privacy

Personal information collected in this form will be used solely for scheduling, communication, and lesson planning.

My Driving Coach LLC will not share or sell your data to third parties.

Video recordings will be stored securely and will be retained only for the duration necessary to fulfill the training process.

By submitting this form, you acknowledge that you have read, understood, and agree to the terms above, including the dash cam usage policy.



Do you agree to the Terms & Conditions
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report