Administrative Suspensions Drivers
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In order to process your forms, YOU MUST provide your driver’s licence number. You may find this information on court documents, your road side suspension documentation, by purchasing an abstract or by visiting an MTO or Service Ontario office in person with proper identification.
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PROGRAM FEE PAYMENT OPTIONS
The program fee for the Back on Track 2 or more administrative suspensions program is $294.
This fee is non-refundable, so read the Participant Agreement carefully.

To register here, you must pay by credit or debit card (VISA or Mastercard) below. If you do not want to register online, click here.
Please allow up to 120 days to:
  • Register for Back on Track AND
  • Complete: Education Course (2nd offence)*
    OR
  • Complete: Treatment Course (3rd offence)*
*This can take up to 90 days from the day you book your appointment

You may only have 120 days to meet your requirement.

Check your Notice of Suspension for your specific requirements!
For information regarding other requirements: licencing or reinstatement, or Ignition Interlock, please contact :

Ministry of Transportation (MTO)


1 800 303 4993


Ignition Interlock:





ALCOLOCK

1 866 658 6374



1 A LifeSaver

1 888 769 6080

Inactive hide details for PARTICIPANT AGREEMENTPARTICIPANT AGREEMENT
1. Requirements for Successfully Completing Back on Track
I understand that I must meet the following requirements to successfully complete Back on Track:
  • I must not use alcohol (including dealcoholized beverages) or drugs within 24 hours of or on any day that I participate in the program.1 I may take medication prescribed by a physician provided it does not impair my ability to participate in the program.2
1. If you are not sure you can meet this condition, you should complete substance abuse treatment before you register for Back on Track. Contact ConnexOntario at 1-800-565-8603 for help in locating treatment programs in your area.
2. If you are unsure if you can meet this condition, you should consult a doctor before registering.
  • I must attend all sessions as scheduled for me and arrive on time for each session.
  • I must give 24 hours notice that I am unable to attend by leaving a message directly with the service provider. The only acceptable reasons for missing a session without giving 24 hours notice are serious illness, a death in my immediate family, or severe weather. In case of an emergency I may submit a document (e.g., a doctor’s note, death certificate, or severe local weather report - must be date/time specific) to confirm the reason for my absence. If accepted, I will be required to reschedule the missed component and complete all assignments.
  • I must provide accurate information about myself and my remedial requirements.
  • I must participate fully in the program activities and demonstrate that I have learned about separating my drinking from my driving.
  • I must treat the program staff and other participants with respect. Verbal or physical abuse will not be tolerated.
2. Consequences
If I do not meet the program requirements for any reason, I have failed the program. I may re-register for the program again but I must repay the program fee in full. In addition, if any accommodation I require results in extra program costs, I will be responsible for paying these before re-registering. I will be required to retake any scheduled or completed components again and complete all parts of the program to meet the Ministry of Transportation, Ontario (MTO) remedial requirement.


Inactive hide details for 3. Consent to Collect and Release Personal Information3. Consent to Collect and Release Personal Information
I understand the following:
  • The Centre for Addiction and Mental Health (CAMH), on behalf of MTO will be collecting personal information from me. The local provider will also collect personal information from me on behalf of CAMH.
(Note: Collection of the personal information as described above is for the administration and operation of the Remedial Measures Program. The authority for the collection and use of this information is in accordance with the Highway Traffic Act, R.S.O. 1990, Chapter H. 8, Section 41.1(6.1) and Section 57(6). If you have any questions about the information collected on this form, please contact the Program Advisor, Licensing Services Branch, Driver Improvement office, Ministry of Transportation, 77 Wellesley Street West, Box 671, Toronto, Ontario M3M 1J8, 416-235-1086 or 1-800-303-4993)
  • This information relates to my identity, program enrolment and participation responses to questions.
  • If applicable MTO will receive any recommendations for medical review.
(Conditions that could result in a medical review include: blackout or loss of consciousness, poor physical co-ordination, a balance problem, visible tremors or shaking, disorientation or confusion, agitated or overly sedated behaviour, and extreme memory problems.)
  • In case of payment issues, my payment records may be shared with financial institutions.
    All personal information that I provide to CAMH and/or the local provider may be shared with MTO through Back on Track's encrypted website, secure email and facsimile transmission, by registered mail or by courier and will be kept as part of my record on an encrypted database. Once I complete the program, only CAMH and MTO will have access to my record unless I give written consent to do otherwise.

    CAMH operates Back on Track on behalf of MTO.
4. Authorizations. Please list anyone you wish to give access to your information in this section, including a translator or helper you need. They will be able to schedule appointments on your behalf and communicate with the program staff if necessary. Listing names in this section is your agreement to give them access to your file.

Name 1:


Relationship:


( ) -

Name 2:


Relationship:


( ) -
Requests to remove an authorized person must be made in writing.


Inactive hide details for 5. Conditions5. Conditions
I also understand the following conditions:
  • If I have a pending court date and am subsequently convicted, I will need to take the three part program for convicted impaired drivers at a cost of $634.
  • The program fee is non-refundable.
  • If I need a language interpreter, translator, helper or any other special arrangement to participate fully in the program, I am responsible for making the arrangements and paying any associated costs. The translator / helper must be 18 years of age or older. My requirements may be decided by program staff.
  • If program staff observe that I have a medical condition that they are concerned could affect my ability to operate a motor vehicle safely, they may recommend a medical review to the Ministry of Transportation. I may be informed if such a recommendation is made.
  • I am responsible for any travel costs to attend any program component.
  • It may take over 3 months to register, schedule and complete the workshop.
  • I am required to begin participation in the program within 5 years of receipt of my registration confirmation. After 5 years, I will be required to re-register by completing this form and paying the registration fee again.

Ontario Driver's Licence number:
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ANNNNNNNNY YNNNN
Name as it appears on your Licence:
Last NameFirst NameMiddle Initial
Common Name (optional, if different than First Name):



Date of Birth:


/


/


<<< use the up/down arrowheads to scroll, then click to highlight the correct day, month and year

day


month


year


Current Mailing Address


e.g. 10-123 MAIN ST NW or RR 5 or PO BOX 4001 STN A ( no commas )


City, Province, Postal Code

, ,


Don't know your Postal Code? Right-click here then 'Open in New Window'

Ontario Telephone Numbers

(enter at least one)

Home:

( ) -



Work (if permitted):

( ) -



Cell Phone:

( ) -



Email:











Confidentiality
Back on Track program staff may need to contact you by telephone. May we use the name 'Back on Track Remedial Measues Program' when calling or leaving messages for you?


You are registering for this program because you have had 2 or more impaired administrative suspensions in 10 years. Identify your most recent offence on the left and the previous offence on the right.

Most Recent Offence (select one below): Previous Offence (select one below):












If you do not complete your Remedial Requirement within 120 days, your licence will be suspended until you have completed the program.

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Program Accommodations

(please check all that apply and indicate any special needs):

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details of special needs or helper, if any:




If a translator/helper is required, please include the name and the number where we may reach them, in section 4. Authorizations.

Please charge the total registration fee of $294 to my card. This payment may appear as 'Back on Track' on my Credit Card statement.

Card:





Card number:


Please note: One registration per participant using one type of card for payment. Split payments are not accepted.

3 digits on back:




Expiry date:

month / year

<<< use the up/down arrowheads to scroll, then select and highlight the correct month and year


Name of cardholder:



PROGRAM EVALUATION (Optional)

You can help us improve Back On Track. Your consent is voluntary and will not affect your participation in the program.
I agree:
To release personal information to an independent program evaluator about my participation in Back on Track.



Ethnoracial Questionnaire
We encourage you to complete this section as we are always working to improve. The information in this section is for the sole purpose of program evaluation by the Centre for Addiction and Mental Health (CAMH).
1. What language are you most comfortable speaking?







2. How comfortable are you speaking English?

3a. Which of the following best describes your ethnoracial identity?














3b. If you answered 'Mixed Background' or 'Other' to question 3a, please specify:
( no Commas ( , ) allowed )

4a. Where were you born?


4b. If you answered 'Elsewhere' to question 4a, what year did you come to Canada to live?
Please note:
Completion of the Ethnoracial section is not required by the Ministry of Transportation of Ontario (MTO). Completion of this section represents consent to participate.



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Important - By filling out this Form and selecting the 'Submit' button, you are signing the Participant Agreement.