NAZARETH SCHOOL DRIVER INFORMATION SHEET

NAZARETH SCHOOL DRIVER INFORMATION SHEET
1. DRIVER
Name:
Date of Birth:

MonthDayYear
Date
Home Address:
Phone #:
Format: (000) 000-0000.
Driver's License #:
Registration Expiration Date:

MonthDayYear
Date
2. VEHICLE TO BE USED
Name of Owner:
Model:
Owner Address:
Vehicle Make:
Vehicle Year:
License Plate #:
Expiration Date:

MonthDayYear
Date
# of Child Safety Seats Available:
# of Passenger Seatbelts:
If more than one vehicle is to be used, the aforementioned information must be provided for each vehicle.
3. INSURANCE INFORMATION
When using a privately-owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle.
Insurance Company:
Policy #:
Expiration Date of Policy:

MonthDayYear
Date
Liability Limits of Policy:
NOTE: The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000.
CERTIFICATION:
I certify that the information given on this form is true and correct to the best of my knowledge. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration, and have the required coverage in effect on any vehicle used to transport youth. I am familiar with the state law requiring that children ride in either a car seat or booster seat until the age of eight, or until they reach the height of 4’9”.
Signature
Date

MonthDayYear
Date
It is strongly recommended that children 12 years of age and under do not sit in the front seat of cars equipped with air bags.
Revised 6/2026

NAZARETH SCHOOL DRIVER INFORMATION SHEET

1. DRIVER

2. VEHICLE TO BE USED

3. INSURANCE INFORMATION

CERTIFICATION:

Submit Car Insurance card and Driver's License