Driver Ed Information and application - Salem School District

Winter 2014 Class
WELCOME TO DRIVER EDUCATION!
STUDENTS MUST BE 16 YEARS OLD BY April 10, 2014
Class 1 – Tuesdays and Thursdays – 6-8 pm – Starting Tuesday, January 7
Class 2 – Mondays and Wednesdays – 2:30-4:30 – Starting Monday, January 6
Class 3 – Tuesdays and Thursdays – 2:30-4:30 – Starting Tuesday, January 7
All classes will be held in Room 137.
Class will be filled based by birth date with the oldest students first. All checks will be deposited. Please bring
the application form, payment and a copy of your birth certificate to Ms. Austin in room 240 by Monday
December 16, 2013. Please make checks payable to: Salem High School for $480.00.
Make sure that you can attend all classes. No more than 2 classes can be missed and they must be made up to
pass Driver Education.
Student driving times will be set up in class. Students must be prepared to drive. They should arrive well
rested, wearing proper footwear, corrective lenses, and you must bring your parent driving log. Any student not
prepared to drive will not drive and will be considered a “no show”. A $30.00 charge will be made for each “no
show” for driving. A 24-hour notice is needed to cancel appointments.
Driver Education class will end according to the respective class schedule. Green Certificates are issued as
soon as all students complete the course. A $20.00 fee will be charged for the replacement of lost Certificates.
Driver Education taken through Salem High School carries ¼ credit applied toward graduation. This will show
up as a pass/fail on your report card. Upon successful completion, students will be eligible for insurance
discounts through their own insurance company.
We’re looking forward to seeing you. If you have any questions you can contact Miss Austin in room 240 or
email me at school: raustin@sau57.org Voicemail: 603-893-7069 Extension 5381
Sincerely,
Ms. Austin
Mrs. Martel
Directors, Driver Education
Class list will be posted
outside Room 137 by
December 19, 2013
Don’t forget a copy of your birth certificate

DRIVER EDUCATION Winter, 2014 PAID ________
DATE ___/____/___
BIRTH CERT. ________
APPLICATION/HEALTH HISTORY
Welcome to Driver Education at Salem High School
The student must be 16 years of age by April 10, 2014.
This form must be returned with payment and a COPY of the student’s birth certificate to Ms. Austin in
room 240 by December 16, 2013.
The cost of Driver Education is $480. Please make check payable to Salem High School.
PARENT PERMISSION
PLEASE choose class in order of preference 1, 2 or 3. I will try to give you the class you choose. DO NOT
LIST A PREFERENCE IF YOU CANNOT ATTEND THAT CLASS.
____ CLASS 1 – Tuesdays and Thursdays 6-8pm – starting Tuesday January 7
____ CLASS 2 – Mondays and Wednesdays 2:30-4:30 – starting Monday, January 6
____ CLASS 3 – Tuesdays and Thursdays 2:30-4:30 – starting Tuesday, January 7
I, ________________________________________________ give my full permission for
(parent signature)
__________________________________________________
NEATLY PRINT (student name)
M or F (please circle)
__________________________________________________, ______________________, NH
(Address)
(Town)
_______/_______/_______ __________________________ _________________________
(birth date) (home telephone) (student cell phone)
to enroll in Driver Education at Salem High School with the understanding that he/she will be under qualified
supervision during the entire course.
Yes
No
A. Heart Trouble _______________ _______________
B. Epilepsy _______________ _______________
C. Paralysis _______________ _______________
D. Cerebral Palsy _______________ _______________
E. Orthopedic Difficulties _______________ _______________
F. Hearing Difficulties _______________ _______________
G. Presently wearing _______________ _______________
glasses/contact lenses
If yes, what vision difficulties are the glasses/contact lenses designed to remedy ________________________

Driver Education
***** Pricing *****
THIS WILL BE THE LAST DRIVERS EDUCATION CLASS OFFERED AT
SALEM HIGH SCHOOL!!!
Applications returned BY December 16, 2013 $480.00
Any applications received AFTER December 16, 2013 $555.00