-

Legal First Name *

Last Name *

Address and Street *

Town *

Zip *

Date of Birth *

Gender *

---MALEFEMALEOTHER

Home Phone *

Parent/Guardian Cell *

Work/Other Phone *

Parent/Guardian E-mail address *

Permit ID# *

Required upon registration (9 digits)

High School you attend *

---CalhounKennedyMepham

Does your child require specialized instruction or additional support *

---YesNo

Additional Information

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

Please make your selections below:

Class Times: 

Car Classes: 7:00 AM, 8:30 AM, 10:00 AM, or 11:30 PM 

LECTURE CLASSES - 7:15 AM, or 8:45 AM (10:15 AM class will be added enrollment dependent)

********** ALL INSTRUCTION TAKES PLACE AT GRAND AVENUE MIDDLE SCHOOL. **********

 SCHEDULE POSTINGS:

 Students must use this link http://www.bellmore-merrick.k12.ny.us/schools/drivers_education to access their schedule online on June 13th, 2024.  Requests for schedule changes must be by email to: tmalloyfader@bellmore-merrick.k12.ny.us by 2:00 PM June 21st, 2024.

Phone calls to the district regarding schedule changes will not be accepted.

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

Final schedule will be posted by 12:00 PM on June 13th, 2024.

********** Refund requests must be submitted by June 21st, 2024 before 3 p.m.**********

Car Times *

---6:00 a.m.2:30 p.m.4:00 p.m.Saturday @ Mepham TBDSunday @ Calhoun TBDSunday @ Kennedy TBD

Lecture Classes *

---Tuesdays @ J.F. KennedyWednesday @ W.C. MephamThursday @ S.H. CalhounSaturday @ W.C. Mepham

Lecture Times *

---3:30 p.m.5:00 p.m.6:30 p.m.Saturday @ Mepham Times will be assigned

SPECIAL REQUESTS

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

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.

IMPORTANT INFORMATION...READ BELOW

Student Signature *

Meeting Information Below

 

Mandatory Meeting

In addition, 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.
Tuesday, February 25, 2020 at 7:00 p.m. @ Brookside School/BMCHSD Administration
Thursday, March 5, 2020 at 7:00 p.m. @ Brookside School/BMCHSD Administration

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 *