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I understand that May Sands Montessori School does not assume any liability for any injuries and/or damages sustained by a student while the students is being transported in my private owned and/or operated vehicle. Additionally I am aware that consumer and motor vehicle reports may be obtained as a volunteer with MCSD. These reports may be procured by the Monroe County School Board or its insurance company representative(s), and may include personal information obtained from state motor vehicle departments, my driving record, as an assessment of my insurability for the insurance program and/or other reports. Driver's Name (as it appears on your driver's license):
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Driver's Date of Birth (mm/dd/yyyy):
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Driver's License Number and State of Issuance:
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Vehicle License Tag & State:
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Make, Model & Year of Vehicle:
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I certify that I meet the following requirements to transport students in my private vehicle: a.) I posses a valid driver's license; b.) I am at least 18 years of age:
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I certify that I have valid automobile insurance which includes the following minimum coverage: a.) Liability - $100,000 each person/$300,000 each accident; b.) Property Damage - $25,000 each accident; c.) Medical Coverage: $5,000 each person:
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