Our Lady of the
________________________________________________________________________________________________________________________________
VOLUNTEER
DRIVER INFORMATION SHEET
I.
Driver: Name_______________________________Date of
Birth________________
Address_____________________________Social
Security #_____________
_____________________________________Phone______________________
Driver’s License
#____________________State Issued_________________
II. Vehicle that will be used:
Name of
Owner___________________________Year/Make___________________
Address of
Owner_________________________Model________________________
_____________________________License
Plate #________________
Registration
Expires______________________Inspection Expires_____________
If more that one vehicle is to be
used, requested information must be provided for each vehicle.
III. Insurance Information:
When using a privately owned
vehicle, the insurance coverage is the limits of
the insurance policy covering that
specific vehicle.
Insurance
Company_____________________________________________________
Policy
Number_______________________________Expiration Date____________
Liability Limits of Policy*________________________________________________
*Please
note: The minimal acceptable liability
limit for privately owned vehicles is $300,000 minimum Bodily
Injury/Property Damage Combined Single Limit; $35,000 Combined Single Limit for
Uninsured Motorist; $35,000 Combined Single Limit for Underinsured Motorist.
Have you had
any moving violations or accidents in the last 3 years? Yes_____
No______
(If yes,
describe on the reverse of this form)
Certification: I certify that the information given
on this form is true and correct to the best of my knowledge. I understand that as a volunteer driver, I
must be 21 years of age or older, hold a valid driver’s license, and have the
required insurance coverage in effect on any vehicle used to transport students.
Signature of
Driver____________________________________Date_________________
8/07ola//9/00dio
Form also available at
www.ourladyoftheangels.org