VOLUNTEER DRIVER INFORMATION SHEET
I. Driver:
Name_____________________________ Date of Birth
Address___________________________
Phone #
Driver License #
II. Vehicle
that will be used:
Name
of Owner______________________ Year &
Make
Owner
Address______________________ Model
______________________________License Plate
Registration
Expires Number of Seats with Belts
If more than
one vehicle is to be used, requested information must be provided for each
vehicle.
III. Insurance Information:
When using a privately owned vehicle,
the insurance coverage is the limit of the insurance policy covering that
specific vehicle.
Insurance
Company
Policy
Number
Expiration
Date
Liability
Limits of Policy*
*Please note: As
of August, 2003: The minimal,
acceptable liability for privately owned vehicles is $250,000/$500,000. It is recommended that parents consider
expanding coverage to $500,000.00 CSL (Combined Single Limit). The additional coverage is considered appropriate
protection and, generally, inexpensive to purchase.
IV. Certification:
I hereby certify that the
information given on this form is true and correct to the best of my
knowledge. I understand that as a
volunteer driver, I must be 21 years of age or older, hold a valid driver's
license, and have the required insurance coverage in effect on any vehicle used
to transport students.
__________________________________________
(Signature)
__________________________________________
(Date)
It is
recommended that a photocopy of the driver’s valid driver’s license and auto
insurance policy be attached to this form.
FORM 6153.88 VOLUNTEER (revised 8/2003)