Volunteer Driver Form Revised - Red Deer Public Schools printable pdf download

RED DEER PUBLIC SCHOOL DISTRICT NO. 104

Student Transportation in Private Vehicles Application

(valid for current school year only)

VOLUNTEER DRIVERS

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

use.

BOARD INSURANCE COVERAGE

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.

VOLUNTEER DRIVER’S INFORMATION:

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.

Commitments:

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.

_________________

___________________________________ __________________________________

Date

Volunteer - Please Print Name

Volunteer - Signature

_________________

___________________________________ __________________________________

Date

Vehicle Owner (if different from volunteer)

Owner - Signature

_________________

___________________________________ __________________________________

Date

Principal or Designate - Please Print Name

Principal or Designate - Signature

Volunteer Driver Form Revised - Red Deer Public Schools

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