• Volunteer Driver Application

    Volunteer Driver Application

    Ride Assist Naperville (RAN)
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Emergency Contacts*
  • Are you a Veteran? (optional)
  • Are you available for last minute requests?*
  • Would you be willing to drive a veteran to Hines Hospital?*
  • Vehicle Information
    Rows
  • Do you own this vehicle?*
  • Do you have a valid IL driver's license?*
  • In the last 5 years, have your driving privileges been suspended or revoked?*
  • Have you ever received a hardship license (JDP)?*
  • Have you ever been convicted of a crime?*
  • With your signature on this application as confirmation, do you approve of the following?
    Rows
  • Please provide us with 2 personal references (excluding relatives)*
    Rows

  • Photographic & Volunteer Release

    In volunteering for RAN, I hereby waive and release Ride Assist Naperville officers, directors, board members, employees, and volunteers from all liability with respect to said transportation and the arrangement for said transportation and agree to hold harmless each of them from claims arising from this service. My signature below indicates my agreement to guidelines set forth by Ride Assist Naperville to volunteers. It also indicates my understanding that volunteering for RAN, I voluntarily assume all risks related to exposure to COVID19. I give permission to the community for the use of my photographs that are taken by staff in order to use for social media.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: