Student Volunteer Driver Transportation form

Kingston Collegiate and Vocational Institute
235 Frontenac Street, Kingston, Ontario K7L 3S7 Telephone: (613) 544-4811 Fax: (613) 544-8795
e-mail: [email protected] web site: http://kcvi.limestone.on.ca
Where Tradition meets the Future – Où la tradition et l’avenir se rencontrent
Principal: Ms. D. Scarlett
Vice-Principal: Mr. J. Bonham-Carter
Vice-Principal: Mrs. M. Bartlett
STUDENT VOLUNTEER DRIVER Transportation Form
1.
This is to certify that ____________________ is driving car vehicle
(Student Driver)
license number _______________ voluntarily to ________________________
(Vehicle License)
(Location)
for __________________________ transporting the legal number of student
passengers for the above vehicle.
2.
I, ____________________, under my guardian’s ____________________,
(Student Driver)
(Guardian’s Name)
insurance policy, have Third Party Liability for at least $1 000 000 coverage
both for the legal protection of the driver and passengers.
3.
I am __________ years of age and in possession of a legal drivers permit.
(Student Driver)
4.
I am aware that I am driving student passengers and will obey all traffic laws
while driving students to and from the activity. I will exercise all necessary
care and caution while operating the vehicle to the best of my ability.
5.
The automobile to be used is in satisfactory, safe condition for this purpose.
6.
Students who I will transporting have completed a “Student Permission to be
transported by a VOLUNTEER DRIVER form (including student drivers).”
Date: ________________________
______________________________
(Vehicle Owner / Guardian Signature)
______________________________
(Student Driver Signature)
Principal’s Approval: ________________________________
This information is collected in accordance with the Municipal Freedom of Information
and Protection of Privacy Act.
Updated May 2009
Limestone District School Board