VOLUNTEER PERSONAL VEHICLE USE FORM

Download Form

NAME__________________ DATE OF BIRTH _

ADDRESS___________________________________

PHONE#__________________________

EVENT/DESTINATION__________________________________________________

YEAR/MAKE/MODEL OF AUTO___________________________________________

LICENSE PLATE #__________ YEAR OF REGISTRATION

INSURANCE CARRIER/AGENT_____________________________________________

Attach a copy of current insurance policy.

Attach a copy of current driver’s license.

I certify that the above information is correct and that the insurance coverage is in force. I understand I must have liability insurance coverage of at least 100,000. I further certify that the above vehicle is mechanically safe and that the pre-trip visual inspection of the vehicle will be completed before each trip: Tires, air pressure, brakes, horn, wipers, fluid levels, head lights, brake lights and turn signals.

Driver/Vehicle/Owner _______________ Date

Note: If you drive your personal automobile on the school’s behalf and you are involved in an accident, by law, your liability insurance policy is used first to satisfy any claims. The schools liability coverage would be used only after your policy limits have been exceeded. The school does not cover, nor is it responsible for, comprehensive and collision coverage for damage to your vehicle. A signed release form should be secured for each rider in the vehicle.

Online driving information: risk.utah.gov

1. Look under Utah Learning Portal, *Risk Training (on the section below)

2. Educational & Independent Agencies (Enter Portal)

3. Watch all videos

4. Get credit by submitting results to hjackson@americanleadership.net