Archdiocese of Mobile - Driver Information Sheet for St. Ignatius Catholic

This form allows our volunteers to drive on field trips, etc. Thank you for volunteering your time!

Driver Information
Driver's Name Driver's Name First Last
Driver's DOB Driver's DOB / MM / DD YYYY
Driver's Address Driver's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Driver's License #
Driver's License Date of Expiration Driver's License Date of Expiration / MM / DD YYYY
Driver's Phone Driver's Phone - ### - ### ####
Driver's Email
Vehicle Information

This will be the vehicle being used. This form is required for each vehicle that will be used.
Vehicle Owner Vehicle Owner First Last
Vehicle Owner's Address Vehicle Owner's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
License Plate #
Date of License Plate Expiration Date of License Plate Expiration / MM / DD YYYY
Model of Vehicle
Make of Vehicle
Year of Vehicle
Number of students this vehicle can accommodate, with seat belts. Please note, all passengers under the age of 13, must be restrained in the rear seat of vehicles
Insurance Information

When using a privately-owned vehicle, the insurance coverage is the limit of the insurance policy covering the specific vehicle.
Insurance Company
Date of Policy Expiration Date of Policy Expiration / MM / DD YYYY
Policy #
Policy Liability Limits - The minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000
Accident Disclosure

In order to provide for the safety of our students or other members of the parish and those we serve, we must ask each volunteer driver to list all accidents or moving violations they have had in the last 5 years.
Please list here an accidents or violations within the last 5 years. Put N/A if this does not apply.
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.
I have completed the "Be Smart-Drive Safe" video curriculum.
Certification

Draw or Type

I certify that the information given on this form is true and correct to the best of my knowledge. I understand That is a volunteer driver, I 17ust 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. Clear

Full Name

I certify that the information given on this form is true and correct to the best of my knowledge. I understand That is a volunteer driver, I 17ust 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 Date Signature Date / MM / DD YYYY

Archdiocese of Mobile - Driver Information Sheet for St. Ignatius Catholic

Archdiocese of Mobile - Driver Information Sheet for St. Ignatius Catholic

Driver Information

Vehicle Information

Insurance Information

Accident Disclosure

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.