The New Village School: Authorized Driver Form

Authorized Driver Form
Student 1*

Last NameFirst Name
Grade Level*
Student 2:

Last NameFirst Name
Grade Level
Student 3:

Last NameFirst Name
Grade Level
Welcome to the New Village School!

We will often draw upon our enthusiastic parent body to assist in driving the children of the New Village School to and from off-site locations. If you are interested in being a driver, please complete this form and return it to school along with a copy of your

1) driver’s license and 2) current automobile insurance.

If there are two parents and/or guardians in your family that would like to

drive the children, each driver is required to fill out this form.

If you NEVER intend on driving children on school business, you can ignore this form.
Your Name:*

Last NameFirst Name
Email*
example@example.com
CA Driver’s License*
Your Vehicle License*
Your Insurance Carrier*
Policy Number*
All parents, volunteers, and school personnel operating their own vehicles to transport students on officially authorized school business or related school activities must have this statement on file with the school prior to driving. Individuals who drive children or conduct business for the school using their own automobiles must have their own insurance coverage.

I understand and agree that I am responsible for keeping this insurance information current and correct. I understand that I am responsible for notifying the school immediately if changes of any kind are made to the automobile insurance policy. This includes, but is not limited to cancellation of the policy. Type a label (Initial here)
All drivers should read, initial and be aware of the following:
Liability Insurance Coverage:
Signature Driver

Clear
Date

MonthDayYear
Date
Should be Empty:

Authorized Driver Form

Welcome to the New Village School!

All drivers should read, initial and be aware of the following:

Liability Insurance Coverage: