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 Name
Last Name
E-mail
*
example@example.com
Contact Phone Number
*
Format: (000) 000-0000.
Pick Up Date/Time
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Return Date/Time
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Destination Name & Physical Address
*
Journey Type
*
Please Select
Field Trip
Student Transportation
Number of Passengers
*
Do you need booster seats?
*
Yes
No
If you need booster seats, how many?
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 or in the van.
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.
Additional Message:
Submit
Should be Empty: