Drivers Release Form

Driver Release 2026-2027
REQUIRED FOR DRIVERS TO OFF-PREMISES TRIPS AND EVENTS
All forms must be submitted by the driver prior to the event. Please check your email for approval status.
Please choose your academic year
What Sponsor (name of Chi Alpha Charter) is this driver release form for?
Please type the full campus name, no initials. example: Winona State University
Charter Leader Name

First NameLast Name
Charter Email for review
A copy of this form will be sent to your charter for review
Insurance
Driver's Name

First NameLast Name
Drivers Phone Number
Drivers Email
example@example.com
Upload picture or file of front and back of Drivers License:

Cancelof
Upload a picture or copy of insurance card or policy:

Cancelof
I confirm that my auto insurance policy is current, in good standing, and meets or exceeds state minimum requirements. Should my coverage change after signing this form, I will notify Chi Alpha immediately:
Driver Information
How many years have you held a valid drivers license?
Please provide your current age:
In the last 3 years, have you been cited for one or more minor traffic violations (slight speeding, running a stop light, failure to use blinker, etc.)
Please describe the minor traffic violation(s):
In the last 3 years, have you been convicted of any major traffic violation(s) (DUI, reckless driving, etc.)
Please describe the major traffic violation(s):
Vehicle Safety
Number of working seat belts in your vehicle:
As required by law, I guarantee that all occupants will be wearing seat belts while this vehicle is being operated and comply with the safety requirements of the vehicle including but not limited to airbags:
The automobile being driven for the specified event(s) is in good working operation, has been regularly maintained and inspected and I have no concerns regarding the safety of my vehicle:
I will caravan with the group (as applicable) and will keep in close contact with the staff during this trip.
I will not use a cell phone (except hands free) while operating this vehicle.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I affirm that the above information is accurate and correct and I will carry insurance on the vehicle being driven, and I will notify Chi Alpha if my insurance is cancelled or if any of the above information changes. I will always operate this vehicle in a safe manner while transporting passengers. I certify that I am at least 18 years old; that I have read and understand this Agreement; and that I agree to operate the approved vehicle safely and responsibly while transporting passengers to Chi Alpha activities. Furthermore, I agree to release and hold harmless the Sponsor; Chi Alpha Campus Ministries Incorporated; and their respective directors, officers, missionaries, staff, employees, volunteers, and other representatives (collectively, the “Released Parties”) from from third-party claims and reasonable expenses to the extent caused by my negligent, reckless, or intentional conduct, my violation of driving or event rules, or my failure to follow safety instructions.
Signature
Should be Empty:

Driver Release 2026-2027

REQUIRED FOR DRIVERS TO OFF-PREMISES TRIPS AND EVENTS

Insurance

Driver Information

Vehicle Safety