Volunteer to be a Driver : Adventist Christian School Martinez GA

Driver's Full Name:

Driver's Phone

Are you over 21 years of age? Yes No

Driver's License Number:

State in which license is held:

License expiration date:

Do you have a current auto insurance policy? Yes No

Insurance carrier:

Insurance expiration date:

Limit of liability:

Medical/PIP Limit:

Describe any at-fault accidents within the last three (3) years.

Describe any moving violations within the last three (3) years?

I understand that should I be involved in an accident while driving for the school, my insurance will be primary.

I agree I do not agree

Further, I agree not to carry more passengers than the official rated load capacity for my vehicle. All vehicle occupants will be required to wear seat belts (no double belting allowed).

I agree I do not agree