St. Lucy Parish School

Field Trip Driver Information Sheet

With this completed form, please include a copy of your driver’s license, and a copy of your current declaration of insurance coverage.

This information will be kept on file in the school office.

Drivers

#1 Driver Name_________________________________ Birthdate_____________

Address_______________________________________ Zip__________________

Phone_____________________ Social Security No._______________________

Drivers License No.___________________ Expiration Date_____________

#2 Driver Name_________________________________ Birthdate_____________

Address_______________________________________ Zip__________________

Phone_____________________ Social Security No._______________________

Drivers License No.___________________ Expiration Date_____________

Vehicles That Will Be Driven

Make of Vehicle#1_________________ Model of Vehicle __________

Year of Vehicle #1__________ License Plate No._______________

Registration expires________________

Make of Vehicle#2_________________ Model of Vehicle __________

Year of Vehicle #1__________ License Plate No._______________

Registration expires________________

Insurance Information

When using a privately owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle.

Insurance Company_____________________________________

Policy No.________________________________ Expiration_______________

Liability Limits of Policy______________________________

Please note: The minimal recommended liability limit for privately owned vehicles is $100.000/$300,000. You are responsible for advising the school office of any lapse or change of your driver’s license or insurance.

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 25 years of age or older, possess a valid driver’s license, have the proper and correct license and vehicle registration, and have the required coverage in effect on any vehicle used to transport students.

#1 Driver’s Signature______________________________________ Date_____________________

#2 Driver’s Signature______________________________________ Date_____________________

Field Trips include:

Class trips, driving for sports, music performances, theatre arts trips, Student Council trips