Adult Driver Information Form

Adult Driver Information Form
Diocese
This form is for drivers age 21 and older. Drivers between the ages of 21 to 24 may only transport themselves when driving on behalf of the Diocese of Orlando. Drivers must be 25 years of age or older to transport passengers
Name of Driver*
Date of Birth*

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityZipState / Province

Postal / Zip Code
Home Phone
Cell Phone
Drivers License*
Date of Expiration*

MonthDayYear
Date
Name of Owner
Address of Owner*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Make of Vehicle*
Model of Vehicle*
Year of Vehicle*
Drivers Plate*
Registration Expiration Date

MonthDayYear
Date
When using aprivately owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle. Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000. The vehicle owner's insurance is primary and the Diocese of Orlando does not provide insurance for the vehicle owner.

Insurance Company Policy # Date of Policy Expiration Liability Limits of Policy
Insurance Company*
Policy #*
Date of Policy Expiration*

MonthDayYear
Date
Liability Limits of Policy*
I certify that the information given on this form is true and correct to the best of my knowledge. I possess a valid Florida driver's license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle that is driven or trailer that is towed to the location. I further understand that I must be at least 25 years of age if I will be driving a vehicle with passengers.

I grant the Diocese/parish permission to obtain a current driving record from the Florida Department of Highway Safety and Motor Vehicles to confirm that I have an excellent driving record. I understand it is my responsibility to update the Adult Driver Information Sheet if there are any changes to my driv- ing information. (Please initial)
Please initial*
Participants Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Adult Driver Information Form

Diocese