EmailMe Form - TFCA Field Trip Driver Application

Section I - Volunteer Driver Information

Driver Name #1 *

First Last

Driver Name #2

First Last

Section II - Student Information

Student Information

	Name	Homeroom
Student #1
Student #2
Student #3
Student #4
Student #5
Student #6

Section III - Vehicle Information
The school requires volunteer drivers to have a minimum amount of liability insurance. (1) $50,000 bodily insurance liability, (2) $100,000 bodily insurance liability each accident, (3) $50,000 property liability.

Vehicle Information

	Model	Year	# of working seatbelts	Amount of coverage on this car:
Car #1
Car #2

Section IV - Insurance Information

Insurance Company

Have you been in an accident in the last three years? *

Yes

No

If yes, please describe the accident and its cause below.

Have you been ticketed for moving violations within the last three years? *

Yes

No

If yes, please describe the infractions below.

Do you have personal injury protection? *

Yes

No

Have you been convicted for DWI/DUI or alcohol or drugs, or had your license suspended for moving violations, hit and run, eluding an officer, reckless or negligent operation of a vehicle, or driving while under suspension or revocation? *

Yes

No

Note: Our school will not be able to use volunteers with a "yes" answer even if the incident took place before the person became a Christian.

Section V - Requirements for Volunteer Drivers

I certify that for the CURRENT school year:
- My insurance policy meets the minimum insurance coverage requirements as stated above.
- I possess a valid driver's license.
- I will contact my insurance agent to ascertain if there are any liability policy limits or exclusions regarding transporting other students or faculty members on a field trip that might affect my ability to meet the qualifications for a volunteer driver.
- I will maintain the minimum insurance coverage required by the school for volunteer vehicles for the vehicle(s) listed in Section II and only volunteer to drive when insurance policies and coverages are in force.
- I understand that in the case of any type of accident, injury, or vehicle damage, that the school's liability insurance policy does not provide primary or direct insurance on my vehicle. The school's insurance will take effect only after my personal auto insurance limits are exhausted. (Note: This is the only coverage that most nonprofit organizations can provide because of the impossibility of their affording or even obtaining primary or direct coverage on the vehicles of volunteer drivers.)
- I will advise the school of any change in information provided on this form including, but not limited to, involvement in a car accident in which I am cited, any citations for moving violations, nonrenewal of license, termination of license, change of insurance company, change in amounts of insurance coverage, termination of insurance, or change in vehicle.
- Students riding in my vehicle(s) will be seated and both the front and back seat will be secured with individual working seatbelts. (No double belting of children is permitted.) As required by state law, any child under 40 inches tall must be in a child and/or infant seat. Any child, who is younger than eight and between 40 and 57 inches tall be secured in a booster seat. All children over eight years of age or over 57 inches tall must be secured in a seat belt.
- To my knowledge, my vehicle is in safe operating condition (brakes, tires, etc.)
- I will read and follow the Driver and Chaperone Instructions sheet for the field trip.
- I will notify school personnel if I no longer wish to drive or if I wish to be removed from the Approved Driver List.

Section VI - Declaration and Signature

I affirm that I will carefully transport students under my care, including obeying all traffic laws.

The information given on this form is true and correct to the best of my knowledge.

Signature *

Clear

The Frankfort Christian Academy accepts signatures or symbols on this document as though signed in handwriting. The parent/guardian understands and agrees that by including an electronic signature on this document, he or she has agreed to the terms and conditions.

Date *

MM / DD / YYYY

REMINDER

Your Field Trip Driver Application is not complete and you are unable to drive without a copy of your driver's license current vehicle insurance card on file in the office.