Volunteer Driver Form

Trip Sponsor Information

Date of Trip *

Administrator Email Address *

School *

Grade/Club/Group/Activity *

Teacher Sponsoring Trip *

Sponsor Email Address *

Departing From *

Destination *

Additional Comments - Please include number of students you plan on taking in your personal vehicle

Driver Information

Name of Driver *

Driver's Insurance Carrier *

Insurance Agent *

Policy Number *

Driver's License Number *

Expiration Date *

Vehicle Make/Model *

Tag Number *

Tag State *

Vehicle Owned By *

Phone Number *

I hereby offer to provide for the transportation of students of the Phenix City Public School System for the above mentioned trip. In making this offer, I understand and attest to the following:

1. In the event of a vehicular accident, coverage is provided by the volunteer driver’s own automobile insurance. THE SCHOOL SYSTEM DOES NOT PROVIDE INSURANCE COVERAGE SHOULD A VEHICULAR ACCIDENT OCCUR WHILE A VOLUNTEER DRIVER IS TRANSPORTING STUDENTS.

2. I certify that I have automobile insurance coverage with the above named carrier in the following minimum amounts:
Bodily Injury $50,000/$100,000
Property Damage $25,000

3. I certify that my vehicle is in safe operating condition, is equipped with seat belts for each passenger, and all children will be required to have seat belts firmly fastened while the vehicle is in motion.

4. I certify that I hold a valid Alabama or Georgia drivers license to operate this vehicle and I am 21 years of age or older.

5. I understand that no vehicle shall have more than the legal number of occupants and station wagons may take no more than seven passengers, even if they are three seat models.

6. I understand when arriving at the destination, all students will remain safely in the car until a signal from the teacher in charge indicates children may leave the vehicle.

7. I understand that I will not use a school board purchasing card to purchase gasoline for my personal vehicle. Instead, I will purchase gas with my personal funds and request reimbursement.

I have read and understand the school system’s regulations and have attached to
this form a copy of the declaration page of my insurance policy or other
documents showing the above minimum amounts of insurance coverage and the
expiration date of my insurance.

Driver's Signature *

clear

Uploaded copy of Declaration Page of insurance policy (or other documents showing the above minimum amounts of insurance coverage and the expiration date of my insurance). *

Date * +