Online Registration Form

online Registration form

By checking the box below, you confirmed that you have read, understand and agree to our company policy and privacy policy.

Company policy and Privacy policy. *

Yes, I agree.

PERSONAL INFORMATION

* Indicates required field

Name (as it appears on your learner license) *

First

Last

DL Number *

Age *

Email *

Contat Phone Number *

Another Contact Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Note: If you do not have your learner license yet, please send to us as soon as possible.

Your Motorcycle Riding Experience *

No motorcycle experience at all Had little riding experience Had previous experience but haven't ride for a long time Well experienced

PACKAGE & PAYMENT METHOD

Packages *

Compare packages

Payment Method *

Credit Card Cash Cheque Gift Certificate

Discount Code / Gift Certificate Number (if any) *

CREDIT CARD AUTHORIZATION

Note: Unless you are using your credit card for payment, your credit card will not be charged and will only be used as security deposit only.

Credit Card Type *

Name (as it appears on credit card) *

Credit Card Number *

Expiration Date (MM/YY) *

CCV Code *

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

By checking the box below, I declare and certify that I am the primary cardholder on the credit card specified above, giving legal rights to authorize KamenRider School or its employee to incur charges on my behalf. This authorization will automatically expire after the conclusion of my training package, or when I was completely settled all charges, payment, fees and/or damage cost with KamenRider School.

I agree and authorize KamenRider School to charge the above credit card for the followings (if necessary):
1) Training package deposit
2) Training package payment or any outstanding training fees
3) Security deposit or final amount of repair/replacement cost (including parts & labour) of our school motorcycle and/or equipment.
4) NO SHOW or CANCELLATION charges without 48 hours prior notice (plus $50 administration fee)

Credit Card Authorization *

Yes, I agree.

WAIVER OF LIABILITY

I hereby release KamenRider School, and it’s officers, instructors and any related agency, which is sponsoring KamenRider School, from all responsibility of property damage, bodily injury, liability, cost and expenses and claims of every nature and kind however arising from or in consequence of such students participation or behavior in any of the training courses/sessions/lessons conducted by KamenRider School or it’s instructors, and do agree to save harmless the KamenRider School, it’s offers, instructors and any agency sponsoring KamenRider School, from all claims and rights of action which may arise through my participation in any training session. I am also aware of the fact that in learning to ride a motorcycle/scooter there is risk of injury to myself.

I have read, understand and agree all terms and conditions under company policy and waiver of liability, and am over 19 years of age and I am signing the above liability release freely of my own will. (If you're under age of 19, your parent or legal guardian will need to sign again on your behalf at the first training session)

Waiver of Liability *

Yes, I agree.

NOTE: Your IP address will be recorded for security purposes.