RoadSafetyBC - RDP - Registration Form - CAMH RoadSafetyBC

Responsible Driver Program

I have been referred by RoadSafetyBC to the Responsible Driver Program.

I must successfully complete all three parts of the RDP to have my licence reinstated or to maintain my driving privileges.

I have been referred and/or required to complete a remedial driving program under s. 25.1 or 25.2 of the Motor Vehicle Act, as applicable.

Last Name

First Name

Middle Initial

Date Of Birth

Driver's License

Mailing Address

City

Province

Postal Code

Lookup Postal Code

Primary Phone

Extension

Primary Email Address

Secondary Phone

Extension

Secondary Email Address

Please make sure that your contact information is kept up to date with CAMH and ICBC.

Also, you should regularly check your email junk/spam folder for any email correspondence from CAMH.

May we use the name Responsible Driver Program when calling or leaving messages for you?

Program Accommodations

Please check any that apply:

If a translator or helper is required, please complete the following Consent form and provide their name and phone number where they may be contacted.

Terms and Conditions

To pass the program, you must meet the following requirements:

Do not use alcohol (including dealcoholized beverages), drugs or cannabis products (including CBD products that may contain THC) 24 hours prior to, or during, any component session participation.

Attend all scheduled sessions and arrive on time for each session.

Give 24 hours notice that you are unable to attend by leaving a message directly with the service provider.

Participate fully in the program activities and demonstrate that you have learned about separating your drinking and other drug use from your driving.

Provide accurate information to program personnel.

Treat the program staff and other participants with respect.

Ensure that your payments are made in a timely manner and that you complete the program within the applicable timeframe. CAMH disclaims any liability related to your failure to pay in a timely manner or complete the program in the applicable timeframe.

Participants that fail to comply with the requirements may be removed from the program.

RoadSafetyBC makes all decisions regarding a participant's ability to remain in or retake the program.

Additional Charges

I understand that I must attend all scheduled appointments and meet program requirements. I understand that if I do not complete the RDP, I may be required to pay another RDP fee to re-register for the RDP. CAMH may charge additional fees to re-take any components I do not attend or complete.

Retaking Screening appointment $240.00
Retaking Level 1 or Level 2 workshop $400.00
Retaking the Follow-up appointment $100.00
Disputes of credit card payments $50.00
Declined credit card payments $10.00

Please note: Refunds are issued only in exceptional circumstances.

By clicking this checkbox, I electronically sign this form, and I acknowledge that I have read and understood the Responsible Driver Program Requirements set out above and I am agreeing to participate in the program as described.

Acknowledged

Payment Options

Credit Card Input

Credit Card Tokenization Consent

I consent to CAMH acquiring a payment token for the above card, and submitting an authorization for the amount selected above.
No payment will be taken until my program eligibility has been confirmed.

It takes approximately 3 business days to process registrations once received. When we have processed your registration, you will receive confirmation via email with further instructions.

Video Conference Acknowledgement

I, the Participant, have both the willingness/ability and or will make effort to participate using the technology being requested (i.e. computer with web cam, laptop with video, smart phone with camera and a microphone). This is one of the options to meeting the program requirements with mandatory attendance. I hereby consent to the use of videoconferencing (i.e. Skype, OTN, Zoom, Teams, Webex etc.) to meet my requirement(s) facilitated via videoconference by one of the Service Providers offering the program, managed by the Centre for Addiction and Mental Health, CAMH.

I am aware that I need to treat each session as though it is in-person and must adhere to all the program requirements including participating fully to complete the program and meet all program requirements. I must be in full camera view during the entire session (if using a helper/translator both must be in full view and be on time to start and back from breaks). No part of this session will be recorded, taped, or saved by any individual participating. You must have a private and silent location (where you will not be interrupted and must be alone unless you have discussed the need for a helper or translator) and available for the entire session(s) (locations may not include a vehicle, or public place unless agreed upon in advance with the Service Provider).

Interruptions by another party (children, partners, pets etc.) or long absences (returning late from any break, or extended washroom visits) will be deemed a violation and the session will be terminated. Not meeting any of the above condition(s) will result in an incomplete session. The Participant will be required to pay for the incomplete session before being permitted to rebook the incomplete session.

Please note:

Use of electronic communication can increase the risk of said information being disclosed to third parties despite reasonable efforts to protect privacy security of electronic communication.
It is possible that through electronic communication, malware may be introduced to the computer.
A continuous poor connection, overloading of circuits and other disruptions may result in the rescheduling the program. In addition, if inevitable delays occur that impact licence status or licence reinstatement, they are the responsibility of the Participant.

Acknowledged

Responsible Driver Program

Name

Date Of Birth

Driver's License

Mailing Address

Primary Phone

Secondary Phone

Primary Email Address

Secondary Email Address

Program Accommodations

Payment Options

Credit Card Information Provided

Credit Card Tokenization Consent Accepted

Terms and Conditions

I have acknowledged all of the Responsible Driver Program requirements Accepted

I have acknowledged the additional charges that may be required Acknowledged

I have acknowledged the Video Conferencing Acknowledgement Acknowledged

IMPORTANT: By filling out all of the information on this form and "selecting" the submit button you agree that you have READ off of the information and are signing the Participant Agreement.