Driver Field Trip Information Form

Driver

Full Name *

Phone *

Address

Apt, suite, etc.

Country

City

State

Zip code

Drivers License Number *

Date of Experation *

Vehicle that will be used

Name of Owner *

Address of Owner *

Apt, suite, etc.

Country

City

State

Zip code

Model of Vehicle *

Make of Vehicle *

Year of Vehicle *

License Plate Number *

Date of Expiration *

Registration Expiration Date *

If more than one vehicle is to be used, the aforementioned information must be provided for each vehicle.

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 Number *

Date of Policy Expiration *

Liability Limits of Policy *

(*Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000)

In order to provide for the safety of our students or other members of the parish/school and those we serve, we must ask each volunteer driver to list all accidents or moving violations they have had in the past five years: *

Please Type None if None

Please be aware that as a volunteer driver, your insurance is primary. There is a policy that would offer additional liability protection should a claim exceed the limits of your policy.

Certifications

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 insurance coverage in effect on any vehicle used to transport students. I agree that I will refrain from using a cell phone or any other electronic device while operating my vehicle.

Signature

Reset Signature

Date *

Driver Field Trip Information Form

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