Volunteer Driver

If more than one vehicle is to be used, information must be provided for each vehicle.

Please be aware that as a volunteer driver, your insurance is primary. Thank you for helping us with our transportation needs.

Driver
Driver Name*
First Last
Driver Address*
Street Address Address Line 2 City State ZIP Code
Driver Email*
Driver Phone*
Driver Date of Birth*
MM
DD
YYYY
Drivers License #*
State Issued*
Vehicle
Owned by above named driver?*
- Yes
- No
Owner Name*
First Last
Owner Address*
Street Address Address Line 2 City State ZIP Code
Owner Phone*
Year of Vehicle*
Make of Vehicle*
Model of Vehicle*
Registration Expiration Date*
MM
DD
YYYY
License Plate #*
Insurance
Please be aware that as a volunteer driver, your insurance is primary.
Insurance Company Name*
Policy Number*
Expiration Date*
Liability Limits*
Minimum limits of $100,000/$300,000 required.
Safety Verification
In order to provide for the safety of those we serve, we must ask each volunteer to answer the following questions:
I have NOT had a conviction for an infraction involving drugs or alcohol (such as driving under the influence or driving while intoxicated) in the last three years.*
- True
- False
I have NOT had two or more convictions for an infraction involving drug_ or alcohol (such as driving under the influence or driving while intoxicated) in the last seven years.*
- True
- False
I have had no more than three moving violations or accidents in the last three years.*
- True
- False
I certify that the information given on this form is true and correct to the best of my knowledge. I understand driving for Church ministry is a profound responsibility and I will exercise extreme care and due diligence while driving. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle. I agree that I will refrain from using a cell phone or any other electronic device while operating my vehicle.*
- Yes, I agree.

Volunteer Driver

Driver

Vehicle

Insurance

Safety Verification

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