DMS Volunteer Driver Form
Volunteer drivers must provide the following information, read and electronically sign the DMS Volunteer Driver Policy. Volunteers must also read and electronically sign the Criminal History Affidavit.
Email address *
Name *
Your answer
Cell Phone Number *
Your answer
What grade(s) would you like to serve as a volunteer driver? Select one or more. *
Required
21 Years or Older *
Driver's License Number *
Your answer
State *
Your answer
Driver's License Expiration Date *
Your answer
Auto Insurance Company *
Your answer
Policy Number *
Your answer
Insurance Policy Expiration Date *
MM
/
DD
/
YYYY
Year/Make/Model of Car *
Your answer
License Plate Number *
Your answer
Registration Valid Until *
MM
/
DD
/
YYYY
Criminal History Affidavit **OR** Fingerprint Card
Volunteers must read the Criminal History Affidavit and electronically sign the statement below.
You can find the Criminal History Affidavit here:
http://desertmarigold.org/wp-content/uploads/2015/12/Criminal-History-Affidavit.pdf

Electronic Signature Criminal History Affidavit *
I hereby certify under penalty of perjury that my signature given below is true and correct that I am not awaiting trial or have ever been convicted of or admitted in open court or pursuant to a plea agreement committing any of the offenses listed in A.R.S. § 41-1758.07 in the Criminal History Affidavit listed above. (Put your Electronic Signature on line below)
Your answer
Fingerprint Clearance Card *
Parents may be asked to drive (drop off/pick up) students for overnight field trips, but only Desert Marigold Employees or employees/volunteers of a company contracted for the field trip, with valid AZ Fingerprint Clearance cards can chaperone an overnight trip. Please go to the AZ Department of Public Safety to learn more about the card or check on the status of your application. You can apply at Fieldprint Fingerprinting http://fieldprintarizona.com
Required
Fingerprint Clearance Card Number
(OPTIONAL: ONLY FOR OVERNIGHT TRIPS) If you have a fingerprint card please list card number and expiration date.
Your answer
Passenger Restraints & Seating
Seat Belts
There must be a working seat belt for the driver and each passenger. The driver will enforce that all students must have an individual shoulder strap seat belt securely buckled. Absolutely no “Double Buckling” is allowed.

Booster Seats
Any student under 8 years old who is also 4'9" tall or shorter must be secured in a child restraint system.
Child restraint systems must be correctly installed in accordance with the manufactures code.
The car seat back must be higher than the child’s ears. If not, a high back booster seat must be used to help protect the child’s head and back. Please note that, for practical reasons, all booster seats must be labeled with the child’s name.

Seating
All students under 12 years old and under 4’9’’ tall must ride in the back seats. A child age 12 years old or older and over 4’9” tall may ride in the front passenger seat.

Use of Electronic Devices
Cell Phones
Volunteer drivers aren't allowed to use cell phones (call or text) while driving students. In case of an emergency, the driver must stop and make the necessary calls.

Electronic Devices
Student passengers may not use cell phones, computers, gaming, electronic music or video devices while on a school field trip. The Volunteer Driver has the right to remove and hold the student’s electronic device to turn over to the person in charge of the field trip.

Vehicle’s Safety Condition
The Volunteer Driver must ensure that the vehicle is safe, which includes but not limited to checking the following:
Brakes, including the emergency brake, are in good working order
Tires have a legal tread depth (at least 3/32”)
Brake lights, turn indicators, and headlights are in good working order
Windows are clear and provide an unobstructed view for the driver
Functioning rear view mirrors
Vehicle rated capacity of ten passengers or less
Car Etiquette
Eating & Food Sharing
Due to food allergies and/or specific dietary restrictions for students, the volunteer driver shall not allow any eating in the vehicle. Food sharing is not permitted in DMS classrooms. The students may only have their own water bottles. For overnight trips, eating may be allowed with the permission of the vehicle owner and lead teacher.

Student Behavior & Discipline
If a student’s behavior is inappropriate, the volunteer driver will notify the lead teacher as soon as possible. It will be the lead teacher’s responsibility to assess the situation and administer an appropriate consequence if it appears necessary.

Music & Media
No music or radio shall be played in the car on short day field trips. No recorded music is permitted in the classroom. For overnight trips, age appropriate music and lyrics may be played with the permission of the lead teacher.
Insurance & Liability Policy
In the event of an accident while on a school-related activity, any claims will be tendered to the driver’s personal automobile insurance company, and the driver’s insurance is primary. Note that DMS insurance provides coverage should a claim be in excess of the primary insurance policy limits.
I have read and understood the following guidelines and agree to abide by all the rules and standards set forth therein. *
Required
Privacy Note
Desert Marigold School protects your personal information. Any information provided in this form is strictly confidential. Only your name, email and phone number will be shared with the class teacher(s).
I attest that all of the information provided on this document is true. *
Required
Electronic Signature *
Your answer
A copy of your responses will be emailed to the address you provided.
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