VOLUNTEER DRIVERS

Volunteer Driver Form

If the vehicle you will be operating is to be used for transporting Hood View Adventist School students, including your own child/children, please upload a copy of your car insurance below:

Driver Information

Name of Driver:

Phone:

Address:

Driver License Number:

State:

Date of Birth:

Expiration Date:

Vehicle Information:

Name of Owner:

Phone:

Year:

Make:

Model:

License Number:

State:

Insurance: Oregon State’s mandatory insurance law requires every driver to be covered by liability insurance. The minimum insurance a driver must have is:

Bodily Injury and Property Damage Liability

● $25,000 per person; $50,000 per crash for bodily injury to others, and $10,000 per crash for property damage to property of others.

Personal Injury Protection

● $10,000 per person for reasonable and necessary expenses one year after a crash, for medical, dental, and other services needed due to the crash.

Uninsured Motorist Coverage

● $25,000 per person; $50,000 per crash for bodily injury

Insurance Company:

Phone:

Expiration Date:

Coverage:

Per Person: $

Per Accident: $

Property Damage: $

Medical Payments: $

Uninsured Motorist: $

Driver's Record:

Explain in detail all accidents and/or citations for moving violations received by you during the last 3 years:

None

Written below.

Details:

Have you ever had any drivers' license suspended or revoked?

No

Yes. If yes, explain in detail below.

Details:

Driver's Pledge

I, the undersigned operator of a vehicle to be used to transport Hood View Adventist School students, other than my own child/children, by signing pledge to:

● Always operate the vehicle in a safe manner and in compliance with all laws and safety regulations pertaining to vehicle operation.

● Provide seating for students only in appropriate seating positions and with safety belts that are in good working condition. Furthermore, I will visually check to make sure that each student occupant has his/her safety belt properly fastened prior to operating the vehicle. (Students under no circumstances are to be transported in the cargo area of a vehicle.)

● Have students between the ages of 4 and 6 years and weighing between 40 and 60 pounds be secured in an approved and properly installed child safety system (child safety seat) that elevates the child so the

safety belt properly fits. Child safety systems must meet all federal standards and must be provided by the parents of students who are required by law to have them.

● Never place students in my vehicle in seats in which the supplement restraint system (front air bag) is activated in front of the student.

● Have read this document completely and that all information that I have provided is true and accurate to the best of my knowledge.

$25,000 per person; $50,000 per crash for bodily injury to others, and $10,000 per crash for property damage to property of others.

Signature:

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Date: