St. Mary's High School Driver Education Permission/Registration Form Spring 2021
This information will be used to complete your certificate, be sure it is correct!
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Last Name *
First Name (Full) *
Number / Address *
City / Town *
Zip Code *
Parent Email Address *
Student Email Address
Parent Phone number *
Student Phone number
Date of Birth *
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/
DD
/
YYYY
Permit 9-Digit ID Number (Please write as XXX-XXX-XXX) If you don't have a permit at this time, please fill in 000-000-000. *
Parent Signature: Parent Signature: By typing your full name on the line below, you agree to giving your son or daughter (whose information is listed above) permission to attend the Driver Education Program conducted at St. Mary’s High School during the Spring 2021 semester. The course will commence from February 15 and continue through June 12. There will be no classes from April 4 through April 10. *
Additional Information
Must be at least 16 years of age and have a Drivers Permit at the start of the session.

* A Clear Photocopy of your Permit must be mailed to St. Mary’s High School, Attn: Driver Ed Program, 142 Laverack Ave., Lancaster, NY 14086

**If you do not have your permit at this time…be sure to mail a copy to St. Mary's as soon as possible. Your MV-285 Certificate of Completion (“Blue Card”) will not be issued unless you submit the copy. ABSOLUTELY NO 5-Hour Certificates will be issued with this course (but may be offered separately).

Step #1 - Please select the one in-class time below to indicate your understanding that you must be able to attend the classroom session to enroll. Please note that the classroom instruction will be conducted virtually through Google Meets. Instructions will be sent out via email at a later time from Christopher Hoffman, the Driver Education Coordinator. *
Step # 2 - Choose the In-Car Days of the week that you will be able to attend. Driving sessions will be as follows: Monday - Friday 3:00 pm - 4:30 pm; 4:30 - 6:00 pm; 6:20 pm - 7:50 pm. On Saturdays, times will be 8:00 am - 9:30 am; 9:30 am - 11:00 am; 11:00 am - 12:30 pm; 1:00 - 2:30 pm; 2:30 pm - 4:00 pm. Please note that, due to COVID-19, there will be four (4), one-and-a-half hour individual driving sessions for a total of six (6) hours of driving lessons. This will be scheduled over the entirety of the course.   *
Required
Notes - Please list any specific requests or accommodation needed here. Please note that if you can only make specific times on certain days, please make mention of those requests here.
Please indicate the check number from which the $750 registration will be paid. *
Additional Information
Remember, we will try to accommodate everyone’s selections, but there is no guarantee!


Please contact your classroom instructor or in-car instructor directly regarding make-up sessions.

Refund Policy:
Should the student withdraw or be dismissed after the first classroom session, refunds will not be issued.


Makeup Policy:
For missed classroom sessions, homework will be provided for the student to cover the materials missed. For missed driving lessons without 24-hour notice, each missed 45-minute lesson will incur a $50 fee that will be made up near the end of the course at an agreed upon time.


Contact Christopher Hoffman at choffman@smhlancers.org with any questions!


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