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Chawanakee USD  |  E  3541.1  Business and Noninstructional Operations

Transportation For School-Related Trips   

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SCHOOL DRIVER REGISTRATION FORM

Driver (circle one): Employee Parent/Guardian Volunteer

Name: Date of Birth:

Address: Driver's License No.:

Telephone No.: ( ) Expiration Date:

VEHICLE INFORMATION

Name of Owner: Year:

Address: Make:

License Plate No.:

Registration Expiration: Seating Capacity:

INSURANCE INFORMATION

Insurance Company: Policy No.:

Telephone No.: Expiration Date:

I carry at least the following minimum public liability insurance:

Bodily Injury: $100,000¬ó$300,000 per accident

Property Damage: $50,000 per accident

Medical Payments: $2,000 per accident

Principal or designee to verify current license, registration, and insurance on the above driver, and initial:

HOLD HARMLESS AGREEMENT

I/We agree to defend, indemnify and hold the district, its employees, officers, Board members, agents and representatives harmless from any and all claims, including, but not limited to, claims fro personal injury or property damage brought by third parties for such claims caused or contributed to by any negligent act or omission by me/us in the course of performing voluntary work for the district or in any way arising out of voluntary work for the district.

DRIVER STATEMENT

I certify that I have not been convicted of reckless driving or driving under the influence of drugs or alcohol within the past five years and that the information given above is true and correct. I understand that if an accident occurs, my insurance coverage shall bear primary responsibility for any losses or claims for damages. My vehicle is equipped with seat belts and I agree to enforce all seat belt laws.

Name: Date:

Exhibit CHAWANAKEE UNIFIED SCHOOL DISTRICT

version: November 26, 2002 North Fork, California

revised: June 2004

revised: March 13, 2008

____________________________________________________________________________

TRANSPORTATION FOR SCHOOL-RELATED TRIPS

DRIVER INSTRUCTIONS

When using your vehicle to transport students on field trips or other school activity trips:

1. Be sure that you have registered with the district for such purposes and have a valid driver's license and current liability insurance at or above the minimum amount required by law for each occurrence.

2. Check the safety of your vehicle: tires, brakes, lights, horn, suspension, etc.

3. Carry only the number of passengers for which your vehicle was designed. If you have a pickup truck, carry only as many as can safely sit in the passenger compartment.

4. Require each passenger to use an appropriate child passenger restraint system (child car seat or booster seat) or safety belt in accordance with law.

5. Do not smoke a pipe, cigar, or cigarette while there are minors in the vehicle, as required by law.

6. Obey all traffic laws.

7. Take the most direct route to the destination or event without unnecessary stops.

In case of emergency, keep all students together and call 911 and the district office.

Exhibit CHAWANAKEE UNIFIED SCHOOL DISTRICT

version: November 26, 2002 North Fork, California

revised: June 2004

revised: March 13, 2008