School Use of Private Vehicle Form: EEAG-E

When private vehicles are used for transporting pupils to school sponsored activities, the driver MUST:

a. Be a properly licensed adult (at least 21 years of age).

b. Have an automobile insurance policy providing for at least $100,000 bodily injury liability and $300,000 bodily injury liability per occurrence.

c. Thoroughly check the vehicle insurance to be certain of the coverage for transporting students.

d. Fill out the following information for each trip and keep it on file at the school office.

____________________________
Name of Driver (print)

________________________
School Driving For

___________
Date of Trip

____________________________
Street Address

________________________
Destination

____________________________
City/State

________________________
Activity

____________________________
Telephone

____________________________________________
School Official Requesting Transportation For This Trip

 

All information contained hereon is true to the best of my knowledge.

____________________________
Make and Year of Vehicle

____________________________
Insurance Company

________________________
Signature of Driver

____________________________
Policy Number

________________________
Expiration Date

____________________________
Limit of Liability

____________________________
Signature of School Principal

________________________
Date

Request for above trip:

_________________     _________________           
Approved                        Not Approved

 

To be completed in duplicate--one copy for driver and one copy for Principal's file.