STUDENT TRANSPORTATION CONSENT FORM
This form is to be completed by staff and volunteers transporting students in private vehicles for School District of Beloit related activities.
If you plan to volunteer your time and vehicle to transport students for school district sponsored functions, you must agree to and abide by the following conditions: 1. I am a consenting adult 18 years of age or older. 2. I have a valid driver's license. 3. I give permission for the District to check my motor vehicle record for compliance with the District's safe driver requirements. 4. I give permission for the District to complete a criminal background check and sex offender check. 5. I will only operate vehicles for which I have the proper licensing. 6. I have insurance on my vehicle with minimum coverage as required by state law. I will provide a copy of my insurance policy or a certificate of insurance to the District. (I understand that it is recommended that personal auto policies carry the following limits: $500,000 combined single limit (CSL) Liability, $500,000 Bodily Injury, and $250,000 Property Damage.) I agree that my insurance will be primary for any claims should an accident occur. 7. I will transport no more persons in my vehicle than the number of seat belts available. Each occupant of the vehicle will be required to wear a seat belt. 8. I will not use a wireless communication device of any type while operating my vehicle while transporting students. This includes not only cell phones, but also mobile phones, text pagers, two-way radios, notebook computers, tablets and other wireless devices. 9. I will inspect my vehicle prior to each trip to verify that minimum safety requirements are met, including but not limited to: a. A properly inflated spare tire and functional jack are present. b. Tires are in safe condition and properly inflated. c. All lights and signals are functional. d. Mirrors are present and usable. 10. Accidents - I will take the following steps if I am involved in an accident: a. Unless I am qualified, I will not perform more than basic first aid, and I will move the injured as little as possible. Call for medical aid (if needed). b. Call the police. c. Report all accidents to the Business Office as soon as possible, no matter how small it seems, no later than 24 hours after an occurrence. d. Get names and addresses of all parties and witnesses. e. Exchange pertinent information (name, phone number, insurance company) with other involved drivers. f. Take photos of the accident if possible. g. Fill out any accident forms, if available. h. Refuse talking to the media, and instead refer them to the District.
Check each box below
I have read and understand my obligations listed above concerning transporting students for school district sponsored functions. I hereby assume all the risk associated with my driving activities.
I agree to report in writing to the School District of Beloit within 10 days; a) any conviction or operating privilege withdrawal that makes the operator ineligible to operate a motor vehicle to transport pupils and b) any suspension or revocation of my operating privilege.
I understand that I may not falsify or provide incomplete information in respect to any material fact on this or any other background information form.
This is a required question
This form was created inside of School District of Beloit.
Terms of Service