Van Request Form

Van Request Form

To reserve the HSD vans, please complete and submit the request form below. This form must be completed by the individual who will be driving the van on the requested date.
Full Name of Driver*

First NameLast Name
E-mail*
example@example.com
Contact Phone Number*
Format: (000) 000-0000.
Pick Up Date/Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Return Date/Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Destination Name & Physical Address*
Journey Type*
Number of Passengers*

Please respond to the following questions by selecting "Yes" or "No" : *

Rows	Yes	No
I am older than 21 years of age.
I have a valid Driver's license.
I have had no vehicle moving violations or at-fault accidents within the last 3 years. (Please note: "Yes" means you have not and "No" means you have.)
I have never been convicted of any crimes against children or other persons. (Please note: "Yes" means you have not and "No" means you have.)
I agree to report to the school principal (or designee) any and all accidents, regardless of scope, that I am involved in while transporting district staff, volunteers or students.
I agree to not smoke while transporting students.
I agree to remove trash and personal belongings from the van after my trip.

To the best of my knowledge, the information provided on this form is both true and accurate.

Clear
Additional Message:
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