Application – Nefesh Driver Education

NEFESH SUMMER 2022 DRIVER EDUCATION APPLICATION
Name

Please enter your legal name as it appears on your permit
Name *

First

Middle

Last
Birth Date *

Students are required to be 16 years of age before the program begins. Students under 16 years of age at the start of the program will not be enrolled in the program.
Gender *

Male Female
Permit ID Number

The permit ID number is the nine digit number located on the top of your permit. If you have your permit, please enter your permit ID number in the section below. If you do not have your permit yet, please skip this section and submit your ID number when you receive your permit. ALL STUDENTS MUST HAVE THEIR PERMIT BEFORE JULY 15TH, 2022. NO STUDENT WILL BE ABLE TO RECEIVE THEIR CERTIFICATE WITHOUT PRIOR SUBMITTING THEIR PERMIT ID NUMBER TO US.
Permit ID Number
Mailing Address

Please enter your mailing address as it appears on your permit
Mailing Address *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country *
Phone Number

Please enter your contact number starting with a "1" before your area code
Parent Cell Phone Number *
Student Cell Phone Number *
Parent Email Address *
Student Email Address *
School Now Attending *
Classroom Instruction *

Please select one of the above classes. The classroom instruction is both Monday and Tuesday. The classes are via Zoom. Classes begin Tuesday, July 5th, and end Monday, August 15th.
Driving Instruction

THE PICK-UP AND DROP-OFF FOR ALL DRIVING SESSIONS ARE AT NEFESH ACADEMY, 2005 E. 17th ST, BROOKLYN, NY 11229
Driving Instruction *

Monday & Tuesday 4:30pm
Monday & Tuesday 5:30pm
Other

Please select one of the above driving sessions. The driving instruction is both Monday and Tuesday. Driving instruction begins Tuesday, July 5th, and ends Monday, August 15th. Your driving session can't be at the same time as your classroom session. FOR ALL QUESTIONS, PLEASE CALL 917-970-0013.
Friend Request

You may request to be with a friend in the Driver's Ed car for your driving session. We can not guarantee you will be with the friend you requested, but we will do our best to accommodate your request. REQUESTING A FRIEND TO BE IN YOUR CAR DOES NOT SECURE A SLOT FOR YOUR FRIEND IN THE PROGRAM. EACH STUDENT MUST REGISTER AND MAKE A PAYMENT TO SECURE THEIR SLOT IN THE PROGRAM.
Terms and Conditions

Please check the box after you have read the following terms and conditions
I have read and agree to the Terms and Conditions: WHAT THE COURSE OFFERS Upon successful completion of the course students will receive an MV285 Certificate. This provides them with a Class D driver’s license at age 17 upon successfully passing the NYS road test and submitting their MV285 Certificate to the DMV. It also provides an insurance reduction of 10 to 15% (depending upon your insurance company). The students will receive a professionally taught Driver Education Course that will provide a comprehensive introduction to the driving experience. This will include; rules of the road, traffic safety concerns, defensive driving, proper handling of a vehicle, driving in traffic, and problems of substance abuse as related to driving. This course is not intended to bring a new driver to higher levels of driving performance without adequate practice time outside of course hours. ELIGIBILITY Student must be 16 by the start of the program. Students must obtain a NY State learner’s permit from DMV. COST $585.00 for the course. $35 for the book. Full payment is due when submitting your application. ABSENCES - MAKE-UP No more than 2 absences are permitted in either the car or lecture sessions. It is the student's responsibility to obtain prior approval from the driving and lecture instructor regarding make-up assignments and scheduling. All absences must be made up. There is a $25 fee for each class that is required to be made up. STUDENT OBLIGATIONS 1) I understand that I must successfully complete both the road and theory portions of the course in order to receive a MV 285 Certificate. 2) I will conduct myself in both car and lecture classes in a responsible manner. 3) I understand the absence make-up section of this application. REFUND POLICY A student may request a change of schedule within 48 hours of notification of their schedule. In the event of the withdrawal prior to the first day of the course a $25.00 cancellation fee will be charged. No refunds will be granted once classes begin.
Parental Consent

I hereby give my child permission to enroll in the Nefesh Academy Driver Education program and certify that I am the parent or legal guardian of the above student. To qualify for the N.Y.S. Completion Certificate I understand that my child must successfully complete both the classroom and in-car phases of the course. I have read and understand the requirements for the course and the refund policy outlined in the Terms and Conditions section of this application. The cost of the program is $585.00, excluding the textbook. The book fee is $35.00.
Parent/Legal Guardian Signature *

Clear
Product Selection *

Course/Book via Paypal Account - $620.00 Course/Book via credit/debit card - $635.00 Course only via Paypal Account - $585.00 Course only via credit/debit card - $600.00 Every student is required to have the book "How to Drive" by AAA for the classroom session. You may purchase the book now or you may purchase it the first day of the program at Nefesh Academy. You may also obtain the book from a friend who completed the course.
Payment Method *

PayPal

NEFESH SUMMER 2022 DRIVER EDUCATION APPLICATION

Name

Permit ID Number

Mailing Address

Phone Number

Driving Instruction

Terms and Conditions

Parental Consent