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Atascadero USD |  E  3541.1  Business and Noninstructional Operations

Transportation For School-Related Trips   

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TRANSPORTATION FOR ACTIVITY

Driver (circle one): Employee Parent/Guardian Volunteer

Name:________________________________ Date of Birth:_______________

Address:__________________________ Driver's License No.:_______________

Expiration Date:______________________

Telephone No.: (____)____________________

VEHICLE INFORMATION

Name of Owner:___________________________________ Year:___________

Address:________________________________ Make:__________________

License Plate No.:_____________________

Registration Expires:___________________ Seating Capacity:________________

INSURANCE INFORMATION

Insurance Company:_____________________________ Policy No.:________________

Telephone No.:_____________________________ Expiration Date:________________

Liability Limits of Policy:__________________________________

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.

Name:___________________________________ Date:_____________________

___________________________________________________________________________

TRANSPORTATION FOR SCHOOL-RELATED TRIPS

In many situations, voluntary activity drivers are needed to provide transportation for students to and from various activities. In order to provide this transportation in a manner which insures efficient operation, maximum safety for the students, and a clear understanding of the obligations being undertaken by voluntary drivers, please complete the following questions by checking yes or no and signing on the bottom:

Yes No

1. I have a valid California motor vehicle driver's license

2. I have an insurance policy, in effect, covering my automobile

for Bodily Injury and Property Damage.

3. I have received no citation for reckless driving in the past

5 years.

4. I have had no automobile accident which resulted in injury

to any party during the past 5 years or which resulted from

an unsafe act on my part.

5. I agree to abstain from the use of alcoholic beverages

during times which affect my services as an activity

driver.

6. I agree to follow any reasonable directions of the teacher

in charge of the activity in matters such as departure times,

itinerary, supervision of students, etc.

Authorized drivers are protected for liability under the school district's insurance program.

Must be filed in the Principal's office prior to the activity involved.

_____________________________________________

Signature Date

_____________________________________________

Administrative Approval Date

___________________________________________________________________________

TRANSPORTATION FOR SCHOOL-RELATED TRIPS

DRIVER INSTRUCTIONS

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

1. Be sure that you have registered with the Transportation Department for such purposes and have a valid driver's license and current liability insurance on file 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 truck or pickup, carry only as many as can safely sit in the passenger compartment.

4. Require each passenger to use a safety belt.

In case of emergency, keep all the children together and call 462-4250 or any emergency number listed in the vehicle..

Exhibit ATASCADERO UNIFIED SCHOOL DISTRICT

Version: October 10, 2002 Atascadero, California