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PLACENTIA YORBA LINDA UNIFIED SCHOOL DISTRICT

DMV/Risk Management/PYLUSD Rules & School Driver Registration Form

Important: Remember this form must be filled out each school year for anyone driving students.

District Employees & Parents:

District employees and parents driving their own vehicles to transport students are required to fill out this form

annually or whenever any changes occur regarding the vehicle being driven.

Proof of car insurance is verified via your signature on the School Driver Registration Form. Drivers are responsible

for all damages and losses to persons and property.

Vehicle capacity is limited to 10 seats or less. If your vehicle capacity is greater than 10 seats, your may transport

your children only.

All Drivers must be at least 21 years of age in order to drive students. Parents may never drive a District vehicle.

District Employees: (includes District employees who work at one site and volunteer at an alternate site)

A DMV Form H-6 Driving Record is required of all employees who transport students. The form is available at the

DMV for a $5.00 non-reimbursable fee. Once your driving record is on file with Risk Management it is updated

annually by the DMV.

Student Drivers:

Students may not drive any other students in their vehicle at any time.

Students holding a provisional driver’s license may not drive between 11 pm and 5 am.

For additional information please refer to

School Driver Registration Form

School/Department: ___________________________________________________________________________

Driver (check all that apply)

Employee (need DMV record)

Parent/Guardian

Student

Volunteer

Name of Driver: ___________________________________

Date of Birth: ______________________________

Name of Student: _________________________________

Telephone Number: (_____ ) _________________

Address: ________________________________________

City: ______________________________________

Driver’s License Number: __________________________

Expiration Date: ____________________________

Vehicle Information

Name of Owner: _______________________________________________________________________________

Address: _________________________________________

City: _____________________________________

Make: ___________________________________________

Year: ____________________________________

Model: __________________________________________

License Plate No.: __________________________

Seating Capacity (including the driver): ______________

Registration Expires: _______________________

Driver Statement

I certify that I have not been convicted of reckless driving or driving under the influence of drugs or alcohol within the past five years and

that the information given above is true and correct. I understand that if an accident occurs, my insurance shall bear primary responsibility

for any losses or claims for damages. I, the undersigned, for him/herself and personal representatives, assigns, heirs, and next of kin,

hereby voluntarily RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO FILE A CLAIM against the Placentia-Yorba Linda Unified

School District, its agents or employees, or the State of California for any injury, accident, illness or death occurring during or by reason of

the activity, or any activities incidental to the field trip or excursion that is the subject of this authorization (Ed. Cod Sec. 35330).

Driver’s Signature: ________________________________________________________

Date: _________________

Parent’s Signature

): _____________________________

Date: _________________

(if student is under the age of 18

Revised 01/09

91005

Placentia Yorba Linda Usd

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