Volunteer Driver Form Revised - Red Deer Public Schools


Student Transportation in Private Vehicles Application
(valid for current school year only)
Your insurance company must be informed that the vehicle you are providing will be used to transport students for
school sponsored activities and whether there will be any compensation or reimbursement planned for such vehicle
The board provides automobile liability insurance coverage only in excess of the $1 million or higher coverage
provided by the vehicle owner, when private vehicles are used to transport students for school-sponsored activities.
The vehicle owner’s coverage applies before the coverage by the board, in the event of any related claims or actions
by other parties. Any damages to the owner’s vehicle are not insured by or deemed the responsibility of the board.
School: ____________________________________
Name of Volunteer Driver: __________________________ Driver License No.: __________________________
Driver’s Telephone No.: _______________________ (home) ___________________________ (work)
Name and Telephone Number of Vehicle Owner (if different from driver): __________________________________
Address of Vehicle Owner: _______________________________________________________________________
Type of Vehicle: ______________________ Make: ___________________ Model: _____________________
Insurance Company: ___________________________________________ Policy No.: _____________________
Agent: ____________________________________________ Liability Limits: __________________________
Please Note: We require a photocopy of the “pink slip” insurance coverage for the vehicle to be used.
1. I agree to drive safely in accordance with the requirements of the Highway Traffic Act and City Traffic Bylaws.
I will advise the principal of any related vehicle accidents, of any suspensions of my license, or changes in the
status of my insurance coverage which may occur after the date of this authorization while this authorization
remains in force (ie. current school year).
2. I have informed my insurer of the planned use of my private vehicle(s) to transport students for school-sponsored
activities, including the frequency of such use. I have also informed them if I will be compensated.
3. I confirm that my driver’s license is valid and has not been suspended; that in the last 36 months, I have not
been convicted of more than two moving violations under the Highway Traffic Act or convicted of any offense
under the Act as a result of an accident; that the vehicle is regularly maintained, is operating properly, and has
no known mechanical defects that impair safe operation of the vehicle; that the vehicle has at least $1 million
of third party property and liability coverage; and that I am 21 years of age or older.
4. I agree to limit the number of passengers to the number of usable seat belts. I will enforce the use of seat belts
in the vehicle. I will comply with the directions of teachers or agents of Red Deer Public School District #104.
5. I accept the foregoing undertakings and certify that the information contained in this application is accurate to
the best of my knowledge.
___________________________________ __________________________________
Volunteer - Please Print Name
Volunteer - Signature
___________________________________ __________________________________
Vehicle Owner (if different from volunteer)
Owner - Signature
___________________________________ __________________________________
Principal or Designate - Please Print Name
Principal or Designate - Signature


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