VOLUNTEER DRIVER APPLICATION FORM

VOLUNTEER DRIVER APPLICATION FORM
We often need help in transporting students to and from field trips, off-campus practice sites, and scrimmages/games. Our school parents have been generous in their assistance. The purpose of this form is to reduce the liability of the school and volunteer drivers by being proactive in our selection of parent drivers. If you are interested in helping with such needs during the school year, please fill out this form and upload copies of your driver’s license, proof of insurance coverage and your current vehicle insurance card. A new Volunteer Driver Application Form must be filled out each school year, and by each volunteer driver.
Section I – Volunteer Driver Information
Name*

First NameLast Name
Driver's License Number*
License Expiration Date
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The school requires volunteer drivers to have a minimum amount of liability insurance.

(1) $100,000 liability for bodily injury per person

(2) $300,000 liability per incident for bodily injury for all vehicle occupants

(3) $50,000-$100,000 liability for property damage.

Please fill out the amount on this (these) car(s):
Car #1 Insurance Company
Policy #
(1) $ amount
(2) $ amount
(3) $ amount
Car #2 Insurance Company
Policy # Car #2
(1) $ amount
(2) $ amount
(3) $ amount
Uninsured/underinsured motorist coverage?

YesNo
Have you been convicted for DWI/DUI of alcohol or drugs, or had your license suspended for moving violations, hit and run, eluding an officer, reckless or negligent operation of a vehicle, or driving while under suspension or revocation in the past five years? [Note: Our school will not be able to use volunteers with a “yes” answer]

YesNo
Section II – Requirements for Volunteer Drivers
I certify that for the school year: (choose school year below)
School Year*
I possess a valid enter state (state) driver’s license
- I will contact my insurance agent to ascertain if there are any liability policy limits or exclusions regarding transporting other students or faculty members on a field trip that might affect my ability to meet the qualifications for a volunteer driver.
- I will maintain the minimum insurance coverages required by the school for volunteer vehicles for the vehicle(s) listed in Section I and only volunteer to drive when such insurance policies and coverages are in force.
- I understand that in case of any type of accident, injury, or vehicle damage, that the school’s liability insurance policy does not provide primary or direct insurance on my vehicle.
- I will advise the school of any change in information provided on this form including, but not limited to, , non-renewal of license, termination of license, change of insurance company, change in amounts of insurance coverage, termination of insurance, or change in vehicle.
- Students riding in my vehicle(s) will be seated and both the front and back seat will be secured with individual working seatbelts. (No double belting of children is permitted.) As required by state law, I will have a child restraint seat for each child under age 6 and weighing 60 pounds or less.
- To my knowledge, my vehicle is in safe operating condition (brakes, tires, etc.).
- I have read and will abide by the Driver and Chaperone Instructions.
- I will notify school personnel if I no longer wish to drive or if I wish to be removed from the Approved Driver List.
Section III – Declaration and Signature
I affirm that I will carefully transport students under my care, including obeying all traffic laws.The information given on this form is true and correct to the best of my knowledge.

Clear
Your Name

First NameLast Name
Date

MonthDayYear
Date
Name of one child*

First NameLast Name
Teacher
Grade
Section IV - Included Documentation
Copy of driver’s license

Cancelof
Proof of insurance coverage amounts

Cancelof
Copy of current insurance card

Cancelof
Should be Empty:

VOLUNTEER DRIVER APPLICATION FORM

Section I – Volunteer Driver Information

Section II – Requirements for Volunteer Drivers

Section III – Declaration and Signature

Section IV - Included Documentation