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First Name *

Last Name *

Address *

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

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.7:30 a.m.9:00 a.m.10:30 a.m.12:00 p.m.

Lecture Times *

---7:30 a.m.9:00 a.m.10:30 a.m.

SPECIAL REQUESTS

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

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

Please make your selections below:

Class 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, however you must attend the class you selected/were assigned for the entire session:

     Monday          6:00 PM @ Mepham

     Tuesday          3:00 PM and 4:30 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 AM @ Mepham

 SCHEDULE POSTINGS:

 Students must use this link http://www.bellmore-merrick.k12.ny.us/schools/drivers_education to access their schedule online on January 23rd, 2024 @ 10:00 AM.  Schedule changes will not be permitted.   

IMPORTANT INFORMATION...READ BELOW

Student Signature *

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 *