Volunteer Driver Questionnaire

Volunteer Driver Questionnaire

Georgia-Cumberland Conference
In an effort to alert volunteer drivers of their responsibilities, as well as to screen volunteers for good driving records, the Georgia-Cumberland Conference has developed a “Volunteer Driver Questionnaire.” ALL volunteer drivers must complete the questionnaire before being approved as a designated driver. The church has an obligation to know if volunteers have good driving records before they are allowed to drive on church functions. The completed forms will be kept on file at the local church. In the event of an accident that results in litigation, the church will then be able to prove that it did ask for driver information indicating the driver’s safety record.
1. The minimum age for drivers is twenty-one (21) years of age.
2. Each driver must be properly licensed and have proper insurance in force. In addition, each driver must have an acceptable record of not more than two traffic citations and no fault accidents in the last three (3) years.
3. No vehicle is to carry more than the official rated load capacity and all passengers must wear seat belts. No double belting is allowed. Violations of this policy could result in insurance refusing to pay claims.
4. Adventist Risk Management requires that volunteer drivers have the required state mandated minimum automobile liability and medical payments insurance and recommends that volunteer drivers have at least $100,000/$300,000 liability coverage. Churches must verify that drivers have at least state mandated minimum automobile liability and medical payments insurance and a valid driver’s license. If an accident occurs, the volunteer’s insurance will be considered the primary coverage and ARM will be secondary up to $3 million.
5. No use of mobile/cell phones is allowed when driving as a volunteer for the Georgia-Cumberland Conference except to call hands-free for emergency services, and no texting or e-mailing is allowed while driving for any circumstance. Volunteers must abide by all laws of the state they are traveling in.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you over 21 years of age? *

Yes No
Driver's License Number *
State in which license is held *
License Expiration Date *

Month Day Year
Date
Do you have a current auto insurance policy? *

Yes No
Carrier
Expiration Date

Month Day Year
Date
Limit of Liability
Medical/PIP Limit
Have you been involved in any at fault accidents within the last three (3) years? *

Yes No
If "Yes," please describe below:
Have you been cited for any moving violations within the last three (3) years? *

Yes No
If "Yes," please describe below:
I understand that should I be involved in an accident while driving for the church/school, my insurance will be primary.

Further, I agree not to carry more passengers than the official rated load capacity for my vehicle. All vehicle occupants will be required to wear seat belts (no double belting allowed).
Driver's Signature *

Clear
Date *

Month Day Year
Date
Church *
Should be Empty: