9: LH BOARDER DRIVER APPLICATION

LEICHHARDT HOUSE: BOARDER DRIVER APPLICATION

For a boarder to have a car at school is a privilege. For such approval to be given, boarders and parents/carers are required to read, complete and then sign the form below.
Before starting this form

Please ensure you have the boarders drivers license information, vehicle details and comprehensive car insurance information.

This form requires signatures from both the boarder and parent/guardian.
- Boarder Name*
  
  First NameLast Name
- Boarder Phone Contact*
  Please enter a valid phone number.Format: 0000 000 000.
- State Boarders D/L Issued
- Boarder D/L Type*
- Boarder D/L Number*
  Please enter a valid D/L number.Format: 000 000 000.
- Boarder D/L Expiry*
  
  MonthDayYear
  Date
- Vehicle Details*
  
  Vehicle Make/Model
  
  Street Address Line 2
  
  Vehicle ColourVehicle Registration Number
  
  Vehicle Colour
- Vehicle Owner Name*
  
  First NameLast Name
- Our business insurer (AJ Gallagher) requires that "The owners of vehicles, driven by a boarder, entering/parking/leaving hostel property should have their own comprehensive insurance cover which would then provide cover should: 1) the vehicle be 'at fault' in causing injury to a person/damage to hostel property or 2) the vehicle be stolen etc. from the premises". Does the owner have comprehensive insurance cover for this vehicle?*
  
  NO (Please see hostel staff)YES (next question)
- Comprehensive Insurance Details*
  
  Insurance provider
  
  Name of insured
  
  Insurance providerPolicy number
  
  Vehicle Colour
- We're sorry but we cannot continue with this application.
  
  I'm sorry, without comprehensive insurance the boarder won't be able to drive a private vehicle to the hostel.
  
  Please arrange for comprehensive insurance then re-apply.
  
  Thank you for your understanding.
- (See Leichhardt House: Boarding Handbook, Section 4)
- Read & Understood
- Read & Understood
- Read & Understood
- By signing this form I understand and agree to the expectations, terms and conditions outlined in this agreement.
  
  I understand that Chinchilla Student Accommodation Association Inc. and Leichhardt House Student Hostel will not be responsibile for any damage etc. that could occur to the vehicle whilst it is entering/parking/leaving hostel property.
  
  I understand that I am required to hand in my keys within 30-minutes of arrival at the hostel and failure to do so will result in my vehicle privelleges being revoked.
- Boarder Signature*
- I understand that boarders taking vehicles to the hostel is a privellege and not a right, this may be revoked by the hosel.
  
  I believe my child has an understanding of the expectations, terms and conditions outlined in this application.
  
  I understand that Chinchilla Student Accommodation Association Inc. and Leichhardt House Student Hostel will not be responsibile for any damage etc. that could occur to the vehicle whilst it is entering/parking/leaving hostel property.
  
  If approved, CSAA Committee will draft a contract to be agreed to and signed by all parties.
  
  *If you or your child are unsure about anything in this application, please clarify with hostel staff.
- Parent/Carer Name*
  
  First NameLast Name
- Parent/carer email*
  example@example.com
- Parent/Carer Signature*
- Date
  
  DayMonthYear
  Date
  AM/PM Option
- Should be Empty:

LEICHHARDT HOUSE: BOARDER DRIVER APPLICATION

Before starting this form