Driver Release Form
REQUIRED FOR DRIVERS OF OFF PREMISES TRIPS AND EVENTS
All forms must be completed by the driver and submitted prior to the event.
Please choose your academic year
Please Select
August 2026-2027
What campus is this driver release form for?
*
Please type the full campus name, no initials. example: Winona State University
Charter Leader Name
First Name
Last Name
Charter Leader Email
A copy of this form will be sent to your charter leader
Insurance
Driver's Name
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Upload picture or file of front and back of Drivers License:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a picture or copy of insurance card or policy:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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:
*
Yes
No
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.)
*
Yes
No
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.)
*
Yes
No
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:
*
Yes
No
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:
*
Yes
No
I will caravan with the group (as applicable) and will keep in close contact with the staff during this trip.
*
Yes
No
I will not use a cell phone (except hands free) while operating this vehicle.
*
Yes
No
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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.
Yes
No
Signature
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Continue
Should be Empty: