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PLEASE COMPLETE THIS FORM IF
YOU INTEND TO DRIVE FOR FIELD TRIPS (SEE
"FIELD TRIP DRIVERS" IN THE VOLUNTEER OPPORTUNITIES ST ST. JOHN
SCHOOL HANDOUT)
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VOLUNTEER
DRIVER
INFORMATION SHEET
DRIVER
Name _________________________________
Date of Birth _______________________________
Address _______________________________
Social Security # ___________________________
_______________________________
Phone # __________________________________
Driver's License # _______________________
License Expiration Date ______________________
VEHICLE THAT WILL BE USED
Name of Owner_________________________
Vehicle Model ______________________________
Owner's Address _______________________
Vehicle Make _______________________________
_______________________
Vehicle Year Model __________________________
License Plate # ________________________
Tag 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#
_____________________________________________________________________________
Policy Expiration Date
__________________________________________________________________
Policy Liability Limits
___________________________________________________________________
PLEASE NOTE:
The minimal acceptable liability limit for privately-owned vehicles
is $100,000 / $ 300,000.
CERTIFICATION
I certify that the information given on this form
is true and correct to the
bect of my knowledge. I understand
that as a volunteer driver, I must be 21 years of age or over,
possess a valid driver's license, have the proper
and current vehicle license and registration, and have the required
insurance coverage in effect on any vehicleused to transport participants of the event.
___________________________________________________
______________________________
Signature Date |
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