Volunteer Driver Application

We often need help in transporting students on field trips or for sports events. LCA parents have been generous in their assistance. The purpose of this form is to reduce the liability of the school and volunteer drivers by being proactive in our selection of parent drivers. If you are interested in helping with such needs during the school year, please fill out this form and return it (along with copies of your driver’s license and your current vehicle insurance card) to the school.

A new Volunteer Driver Application Form must be completed each school year. Copies of your license and insurance card must be updated as changes or renewals occur throughout the school year. A Background Check form just also be completed.

Please complete the form below. Required fields marked with an asterisk *

Driver Information

Full Name*

Answer Required

Driver's License Number*

Answer Required

Driver's License Expiration Date*

Answer Required

Mobile Phone*

Number Required

Email 1*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Vehicle Year/Make*

Answer Required

Number of Working Seat Belts*

Answer Required

License Plate Number*

Answer Required

Insurance Company & Policy Number*

Answer Required

The school requires volunteer drivers to have a minimum amount of liability insurance. (1) $100,000 liability for bodily injury per person; (2) $300,000 liability per incident for bodily injury for all vehicle occupants; and (3) $50,000-$100,000 liability for property damage. Amount on this (these) vehicle(s):

Do you have a minimum of $100,000 liability for bodily injury, $300,000 liability per incident for bodily injury, and $50,000 liability for property damage?*

Answer Required

Yes

Are you licensed to drive a commercial vehicle? (CDL License)*

Answer Required

Yes

Have you been in an accident in the last three years? If you answered YES, please describe the accident and its cause below.*

Answer Required

Yes

Have you been ticketed for moving violations within the last three years? If you answered YES, please describe the infractions below..*

Answer Required

Yes

Accident/Ticket Explanation:

Answer Required

Have you been convicted for DWI/DUI of 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? *

Answer Required

Yes

I have agree the following:*

Answer Required

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(s) required by the school for volunteer vehicles for the vehicle(s) listed in Section I and only volunteer to drive when such insurance policies and coverage(s) are in force.

I understand that in 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.

I will advise the school of any change in information provided on this form including, but not limited to, involvement in a vehicle accident in which I am cited, any citations for moving violations, non-renewal 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 secured with individual working seatbelts. No double belting of children is permitted. As required by Indiana state law, I will have a child restraint (child’s car seat or booster seat) for each child under age 8. Elementary students will be seated in the back seat.

To my knowledge, my vehicle is in safe operating condition (brakes, tires, etc.).The vehicle has been kept in safe operating condition with regular maintenance.

I will notify school personnel if I no longer wish to drive or if I wish to be removed from the Approved Driver List.

I will not make any unscheduled stops unless they have been approved by the teacher.

I will not use a cell phone while operating a vehicle on a field trip.

I have read, agree and understand all the above statements.

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.

I have read, agree and understand all the above statements. 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.*

Answer Required

Yes, I agree

Please type full name, date, and time for electronic signature.*

Answer Required

Please fix the highlighted areas below before submitting.

Volunteer Driver Application