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Legal Name *

(No nicknames, abbreviations, etc.)

Middle Initial

Last Name *

Address *

City *

Zip *

Date of Birth *

Gender *

---MALEFEMALE

Home Phone *

Parent/Guardian Mobile *

Work/Other Phone

Parent/Guardian Email Address *

Permit ID# *

Required upon registration (9 digits)

High School you attend *

---CalhounKennedyMepham

If Guardian Last Name is different please enter here

SCHEDULES WILL NOT BE E-MAILED

Students must access his/her schedule online January 5, 2021 @ 10:00 a.m.

http://www.bellmore-merrick.k12.ny.us/schools/drivers_education

Schedule changes will not be permitted.

Students must refer to the website for changes, cancellations and/or updates.

*** Refund requests must be submitted by January 8th before MIDNIGHT ***

In addition, every student, and a parent/guardian must attend one of the 3 evening meetings of "Driving in the Safe Lane," presented by the Bellmore-Merrick Community Parent Center. This meeting will be done remotely or in person with limited capacity. All meetings will be held virtually using the Zoom platform. Dates and times will be determined.

Car Times *

---6:00 a.m.2:30 p.m.4:00 p.m.Saturday @ MephamSunday @ CalhounSunday @ Kennedy

Special Requests LIST PREFERENCES BY ORDER OF IMPORTANCE

List in order of importance. (car pool requests, block out days etc.)

Lecture Classes *

---JFK TuesdayCalhoun ThursdayMepham WednesdayMepham Saturday

Lecture Times *

---3:30 p.m.5:00 p.m.6:30 p.m.Saturday @ Mepham

Registration and preferences are subject to availability of fleet and are not guaranteed:

Car Days: will be assigned by the District

Car Times (select any TWO): 6:00 AM, 2:30 PM, or 4:00 PM - Saturday and Sunday TBD

Saturday Car Class location: Mepham ONLY.

Sunday Car Class locations: Brookside and Kennedy High School

LECTURE CLASSES - (select any TWO) **Students do not have to attend at homeschool:

Monday          6:00 PM @ Mepham

Tuesday.         4:30 PM and 6:00 PM @ Kennedy

Wednesday     4:30 PM and 6:00 PM @ Mepham 

Thursday        3:00 PM, 4:30 PM, and 6:00 PM @Calhoun

Saturday        8:30 PM @ Mepham

 SCHEDULE POSTINGS:

 Students must use this link https://www.bellmore-merrick.k12.ny.us/driver-education-home to access their schedule online on August 29th, 2025 @ 10:00 AM. Schedule changes will not be permitted.

IMPORTANT INFORMATION...READ BELOW

Student Signature *

Mandated Meeting

 

Every student, and a parent/guardian must attend one of the two evening meetings of
"Driving in the Safe Lane," presented by the Bellmore-Merrick Community Parent Center.

 Date/Time will be determined

Parental/Guardian Consent

I hereby certify that I am the parent or legal guardian of the above student and I hereby grant permission for him/her to enroll in the Bellmore-Merrick CHSD Driver Education Program. I have read and understand the schedule portion, refund policy & student obligations explained in this form.

Parent or Legal Guardian Signature *