Fillable Printable Form MV-TEENS - TEENS Enrollment and Consent Form - New York

Form MV-TEENS - TEENS Enrollment and Consent Form - New York

TEEN ELECTRONIC EVENT NOTIFICATION SERVICE (TEENS)

ENROLLMENT AND CONSENT

As the Parent/legal guardian of:

Young Driver’s Name _____________________________________________________________________

Client Identification Number (License 'ID' #) ____ ____ ____ ____ ____ ____ ____ ____ ____

Birth Date ____ ____ / ____ ____ / ____ ____ ____ ____

I request enrollment in the Teen Electronic Event Notification Service. I understand that notification extends

only to Convictions, Suspensions, Revocations and Reportable Accidents that appear on the young driver’s

license record. I also understand that notifications end after the young driver reaches 18 years of age.

Parent/guardian Name _____________________________________________________________________

Parent/guardian Client Identification Number (License 'ID' #)

____ ____ ____ ____ ____ ____ ____ ____ ____

Relationship to Young Driver, named above ______________________________________________

Parent/guardian Signature

ç_________________________________________________________________

Date ____ ____ / ____ ____ / ____ ____ ____ ____

l Notifications will be mailed to the 'Mailing Address' on the parent/guardian’s license record.

l This form must be completed and submitted for each parent/guardian that wishes to be notified.

Please mail the completed form to:

Office for the Younger Driver

NYS Department of Motor Vehicles

6 Empire State Plaza

Albany, NY 12228

www.dmv.ny.gov

MV-TEENS (10/15)