SUGGESTED DRIVER INFORMATION SHEET

FOR EVENTS/ACTIVITIES OFF PARISH PREMISES

DRIVER:

Name: __________________________________ Date of Birth: ____________

Address: ____________________________ City: ________ Zip: __________

Phone #: ____________________________ E-Mail: _____________________

Driver License #: ___________________________ Expiration Date: ________

VEHICLE TO BE USED:

Name of Owner: _________________________ Model of Car: _____________

Owner Address: _______________________ City: ________ Zip: __________

Vehicle Make: _________________ Year: ________ License Plate # : _______

Registration Expiration Date: _____________ Plate Expiration Date: _________

If more than one vehicle is to be used, the above information must be provided for each
vehicle.

INSURANCE INFORMATION:

When using a privately owned vehicle, the insurance coverage is the limit of the
insurance policy covering that specific vehicle. The minimal, acceptable liability limit
for privately owned vehicles is $100,000.00/$300,000.00

Insurance Company: ___________________ Policy #: ___________________

Expiration Date of Policy: _____________ Liability Limit: _______________

I certify that the information given on this form is true and correct to the best of my
knowledge. I understand that as a volunteer driver, I must be 25 years of age or older,
possess a valid drivers license, have the proper and current license and vehicle
registration. I also understand that my insurance, which is current, will serve as the
primary coverage in the event of an accident.

Signature: _________________________________ Date: ______________________