Volunteer or Student Driver
To qualify as a C.S. Lewis Volunteer Driver, the following conditions must be met.

1) You must operate their vehicles with a valid driver’s license that is not a provisional driver’s license.
(Drivers must comply with ORS 807.122 which limits drivers using a provisional driver’s license from transporting passengers.)

2) You may not have any moving violations on your driving record for the three (3) years (5 years for a DUI violation) prior to their application to act as a Volunteer Driver. In the case of a single minor infraction within the past three years, the applicant may appeal to the Lead Administrator. Please write the specifics of your circumstance on the back of this form or add another page.

3) You must not have any automobile accidents for which they were liable for the five (5) years prior to their Volunteer Driver application.

4) You must provide a copy of their automobile insurance information.

5) Agree by signing this agreement, you will adhere to all traffic ordinances and laws.

6) You have completed and passed a C.S. Lewis Volunteer Background Check.

7) This clearance is good for 5 years. However, the Volunteer agrees to notify CSLA of any major moving violation, at-fault accident or DUI during that time.

Today's date
MM
/
DD
/
YYYY
Driver’s Name (as it appears on Driver’s License)
Your answer
I am a (choose one)
Have you had any moving traffic violations in the past 3 years?
Have you had any insurance company cancel or refuse to provide you with auto insurance?
Have you had your driver’s license revoked, suspended, or restricted?
Have you had any physical impairments other than corrective glasses?
Have you ever been charged with or convicted of “driving while intoxicated” or “driving under the influence”?
If any question(s) 1–6 have been answered with “yes,” please provide full details below: (dates, descriptions, amounts, or other explanation)
Your answer
Agreement
I Agree, by signing this agreement, that I will release, hold harmless, defend and indemnify C.S. Lewis Academy, its agents, employees, and board members, from liability arising out of personal injuries and/or property damage resulting from or in any way connected to transport to and from said activities. By signing below, I affirm that I have carefully read and understood and meet the terms and conditions required of volunteer drivers.

UNDER NO CIRCUMSTANCES WILL CSLA ACTIVITIES USE VEHICLES WITH A CAPACITY GREATER THAN 10 OCCUPANTS (including driver) TO TRANSPORT STUDENTS OR STAFF
UNLESS IT IS AN ODE APPROVED COMMERCIAL CARRIER WITH AN APPROPRIATELY LICENSED DRIVER.

Drivers Phone Number
Your answer
Date of Birth
Your answer
Drivers License Number
Your answer
State and Expiration Date
Your answer
Drivers Home Address
Your answer
Insurance Company Insurance Policy No./Expiration Date
Your answer
Name on Insurance Policy
Your answer
Waiver/Indemnification
I am fully aware my automobile insurance coverage is primary for myself and all passengers I transport to and from school activities. I request that the above-named individual be allowed to transport students to and from activities sanctioned for private transportation by school officials. I hereby release, hold harmless, defend and indemnify C.S. Lewis Academy, its agents, employees, and board members, from liability arising out of personal injuries and/or property damage resulting from or in any way connected to transport to and from said activities. By signing below, I affirm that I have carefully read and understand the terms and conditions required of volunteer drivers.

For STUDENT Drivers
Signatures
Participant and/or ALL parent/guardians if participant is a minor. In the case of guardians in multiple households, please submit a second form.
Volunteer Driver Signature
I acknowledge that I have read and understand this policy. By typing your name in the signature box and clicking submit at the end of this document, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions. (type name)
Your answer
Parent Signature (in the case of a minor driver)
I acknowledge that I have read and understand this policy and give my student permission to be a registered volunteer driver and acknowledge all the responsibilities that come with that position. By typing your name in the signature box and clicking submit at the end of this document, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions. (type name)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of CS Lewis Academy. Report Abuse - Terms of Service - Additional Terms