VOLUNTEER DRIVER INFORMATION SHEET

I. Driver:

Name____________________________________ Date of Birth __________________________

Address__________________________________ Phone # _____________________________

City _____________________________________ Zip Code _____________________________

Driver License # ________________________________________________________________

II. Vehicle that will be used:

Name of Owner_____________________________Year & Make _________________________

Owner Address_____________________________Model _______________________________

__________________________________________ License Plate ________________________

Registration Expires_________________________ Number of Seats with Belts _____________

If more than one vehicle is to be used, requested information must be provided for each vehich

III. Insurance information:

When using a privately owned vehicle, the insurance coverage is the limit of theinsurance policy covering that specific vehicle.

Insurance Company _____________________________________________________________

Policy Number _________________________________________________________________

Expiration Date ________________________________________________________________

Liability Limits of Policy* _________________________________________________________

*Please note:

As of March 2004: The minimal, acceptable liability for privately owned vehicles is $250,000/$500,000. It is recommended that parents consider expanding coverage to $500,000.00 CSL (Combined Single Limit). The additional coverage is considered appropriate protection and, generally, inexpensive to purchase.

IV. Certification:

I hereby 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, hold a valid driver's license, and have the required insurance coverage in effect on any vehicle used to transport students.

_____________________________________________
(Signature)

_____________________________________________
(Date)

It is recommended that a photocopy of the driver's valid driver's license and auto insurance policy be attached to this form. (March 2004)