Madison College Van Reservation Form

1
Criteria to operate a Madison College van:

Madison College employee

18 years old or older

Possess a valid driver’s license

Complete the Madison College driver authorization form
(Unauthorized drivers are NOT allowed to operate a Madison College vehicle)
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Area Code
Phone Number
5
Department* This field is required.
6
Number of passengers?* This field is required.All vans are 12 passenger vans. Vans are tight with 12 adults so please plan accordingly.
2-12 passengers
13-23 passengers
24-35 passengers
36-48 passengers
7
Number of passengers?* This field is required.All vans are 12 passenger vans. Vans are tight with 12 adults so please plan accordingly.
8
Driver Name #1* This field is required.
First Name
Last Name
9
Driver Name #2* This field is required.
First Name
Last Name
10
Driver Name #3* This field is required.
First Name
Last Name
11
Driver Name #4* This field is required.
First Name
Last Name
12
Driver Email Address #1* This field is required.
example@example.com
13
Driver Email Address #2* This field is required.
example@example.com
14
Driver Email Address #3* This field is required.
example@example.com
15
Driver Email Address #4* This field is required.
example@example.com
16
Driver Cell Phone Number #1* This field is required.
Area Code
Phone Number
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Driver Cell Phone Number #2* This field is required.
Area Code
Phone Number
18
Driver Cell Phone Number #3* This field is required.
Area Code
Phone Number
19
Driver Cell Phone Number #4* This field is required.
Area Code
Phone Number
20
Driver #1's affiliation to the college* This field is required.The driver must be a college employee to drive a vehicle
Staff
Faculty
Student Help (must be approved by a supervisor)
Administrator
21
Driver #2's affiliation to the college* This field is required.The driver must be a college employee to drive a vehicle
Staff
Faculty
Student Help (must be approved by a supervisor)
Administrator
22
Driver #3's affiliation to the college* This field is required.The driver must be a college employee to drive a vehicle
Staff
Faculty
Student Help (must be approved by a supervisor)
Administrator
23
Driver #4's affiliation to the college* This field is required.The driver must be a college employee to drive a vehicle
Staff
Faculty
Student Help (must be approved by a supervisor)
Administrator
24
Is Driver #1 authorized to drive having completed the drivers authorization form?* This field is required.All drivers must be authorized through the Office of Risk Management
YESNO
25
Is Driver #2 authorized to drive having completed the drivers authorization form?* This field is required.All drivers must be authorized through the Office of Risk Management
YESNO
26
Is Driver #3 authorized to drive having completed the drivers authorization form?* This field is required.All drivers must be authorized through the Office of Risk Management
YESNO
27
Is Driver #4 authorized to drive having completed the drivers authorization form?* This field is required.All drivers must be authorized through the Office of Risk Management
YESNO
28
Driver Authorization Form

You must complete the Drivers Authorization Form before completing this form.
29
Reason for use* This field is required.ex. Trade Conference, McHenry Volleyball Tournament, Rock Valley softball doubleheader, etc.
30
Departure Date & Time* This field is required.Reservations must be made at least one week in advance
Date
Month
Day
Year
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1
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12
Hour
21
00
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Minutes
AM
AM
PM
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Return Date & Time* This field is required.
Date
Month
Day
Year
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1
2
3
4
5
6
7
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9
10
11
12
Hour
21
00
01
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Minutes
AM
AM
PM
32
Location of travel* This field is required.
33
How many miles do you anticipate traveling on your trip?* This field is required.
34
Worktag to be charged for gas
Fund
Cost Center
Program
Location
Student Activity (if necessary)
35
I agree to fill the tank with gas at the end of the trip.* This field is required.
YESNO
36
I agree to return the keys to the Athletic Office (A2051) at the end of the trip.* This field is required.
YESNO
37
Please verify that you are human* This field is required.
Should be Empty: