Driver Education Application

HOLY CROSS HIGH SCHOOL SUMMER 2024 DRIVER AND TRAFFIC SAFETY EDUCATION PROGRAM
26-20 Francis Lewis Blvd., Flushing, New York 11358

Students must be 16 years of age before Tuesday, July 02, 2024
Effective February 22,2010, New York State Junior Learner Permit holders must have completed 50 hours of supervised driving(15 hours after sunset) and must possess a permit for six months before becoming eligible to take the road test.
The course is approved by the New York state Department of Education and Motor Vehicles.
Students must meet the 24-hour classroom and 24 hour automobile portion of the program. There will be weekly lecture classes scheduled at 8:30 and 10:00 am on Tuesdays, Wednesdays, and Thursdays in Holy Cross HS. The driving sessions will be scheduled upon enrollment and consist of 6 hours of actual driving and the remainder of the time will be observation. Driving lesson cancellations require 24 hour notice.
Upon completion of the classroom & the in-the-car instruction students will receive a Completion Certificate (MV-285). This certificate is necessary for scheduling a road test and must be submitted to the DMV road test examiner. Upon successfully passing the road test and the student’s age of 17, a D license (senior license) will be received. The certificate also provides an insurance reduction to students who qualify.
Full payment must accompany this application. No partial payments will be accepted.
Registration can be completed by mail, online or in person. Complete the form in its entirety. Payment: Mailed applications are accepted if accompanied by fee. Checks made out to HOLY CROSS HIGH SCHOOL, Att: Drivers Education OR payment via credit card for an additional $10 fee. One can also e-use our Online Payment Option.
When filling out application form, use name as it appears on the applicant’s birth certificate. Do not use nicknames.
Classes begin on Tuesday July 02, 2024 and are scheduled to conclude on Wednesday, August 07, 2024.
Road test arrangements are not included and are the responsibility of the student.
Parent/Guardian & student MUST ATTEND a Mandatory virtual ZOOM Orientation on Friday, June 21, 2024 at 5:00 pm.
LEARNER’S PERMIT IS REQUIRED!

Student's Legal Name*
First Middle Last
Student's Home Phone*
Student's Cell Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
High School Currently Attending*
Student's Email*
Age*
Date of Birth*
MM slash DD slash YYYY
9 Digit Permit Number*
Student's Signature*
- Parent/Guardian Consent: The student named above has my permission to enroll and participate in the Holy Cross High School Driver and Traffic Safety Education Program. I have read and understand the information provided at the top of this form.
Parent/Guardian's Name*
First Last
Relationship to Student*
Parent/Guardian's Home Phone*
Parent/Guardian's Cell Phone*
Parent/Guardian's Email*
Parent/Guardian's Signature*
Are you a Holy Cross Student?*
- Yes
- No
$775 for Holy Cross students*
Price:
$795 for non-Holy Cross students*
Price:
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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