Learner Licence Theory Course Driver Education registration form. 3-week course, 2 sessions Mon Thurs, 12-2.30pm "*" indicates required fields Do you live in Rānui?* Yes No Have you had a driver licence before?* No Licence Learner Licence (expired) Restricted or Full Licence (NOTE: This course is for Learner Licence) Disqualified Driver Overseas Driver Licence Overseas Licence, please state country and expiry dateNext Learner Licence course* 7-23 April 2026* 4-21 May 2026 The Learner Licence course is a free course of six sessions for people living locally. It runs for 3 weeks, two days a week – usually on a Monday and Thursday from 12-2.30pm. If you register, you are expected to attend ALL sessions. Address: Rānui Action Project, 476 Swanson Road, Rānui Please let us know if you cannot make any of the dates. ID: You will need to provide ID for your application including a birth certificate (original) or passport; approved photo ID; proof of address, e.g. bank statement or MyIR (IRD). *NOTE: The April course will be on Tuesdays and Thursdays 12-2.30pm.Legal name* First name Middle name(s) Last name Preferred FIRST name – I like to be called: Preferred FIRST name Date of birth* DD slash MM slash YYYY AgeGender* Female Male Non-binary Physical address* Street Address Suburb City Postal code Mobile phone number*Email address* Ethnicity* African Chinese Cook Islands Māori Fijian Indian Latin American Māori/Tangata Whenua Middle Eastern New Zealand European | Pākehā Niuean Samoan Southeast Asian Tokelauan Tongan Tuvaluan Other Asian Other European Other Pacific Peoples Other Ethnicity Ethnicity (other) – please itemise*How did you hear about us?Family or a friend told meAn organisation told me about RAPMSDI walked inRAP FacebookRAP WebsiteRAP Blackboard (outside)RAP flyer/posterAnother RAP activityOrganisation who told me about RAPDo you have English language needs?* Yes No Add my Caregiver / Support Worker details (if relevant): Yes Caregiver / Support Worker Name: First Last Name of Support Agency or Organisation:Caregiver / Support worker email Caregiver / Support Worker phone:Privacy Statement* I agree to the privacy statement.Our Privacy Commitment Rānui Action Project will always treat your personal information with respect and keep it safe to protect your privacy. We collect your personal information so we can contact you and identify you from other people using our services. Also, we gather statistical data for reporting purposes and to help us plan, promote and improve our services. Note: We will only share your identifying information (e.g name, phone number), if you have agreed, or if we are required to under section 88 of the Privacy Act 2020. You have the right to ask for a copy of any personal information we hold about you. And you can ask for your information to be corrected if you think it is wrong.Mailing List I would like to be on the mailing list for RAP (Rānui Action Project) events.
