Driver Agreement Form

Participants that are driving in private and rented vehicles must complete a Driver Agreement at least one week prior to their departure.

Driver Agreement
By Signing below I affirm that: [Required]
I voluntarily agree to drive myself and others to the destination identified on this form. I understand that an auto accident can affect my life, and the lives of others around
me and my vehicle.

I hereby agree to abide by the following driving guidelines:

- Begin the trip well rested.

- I will always check vehicle for defects and adjust safety devices such as seat belts and mirrors before operating.
- I will use the seat belt whenever operating a vehicle.
- I will operate only those vehicles I am trained and licensed to operate.
- I will operate vehicles in a courteous manner, irrespective of behavior of others. I will drive defensively anticipating possible dangers or hazards.
- I will never operate any vehicle when impaired by fatigue, medication, drugs or alcohol or vehicles that I do not feel capable of handling in both normal and emergency
situations.
- Plan routes in advance, divide the trip in segments, and stop for rest when necessary.
- Carry a flashlight, first aid kit, and approved fire extinguisher.
- Have at least one other approved University driver (if using University vehicle)
- Carry one (or more) communication device(s) in vehicle for emergency use.
Valid input:
- Select only one choice.

[ ] I Agree

I am at least 18 years of age, have a valid driver's license, and possess personal automobile coverage as mandated by the state of Illinois. [Required]
Valid input:
- Select only one choice.

[ ] Agree

In the last 18 months, I have not exceeded two at-fault accidents, have had any violation for drunk driving, driving under the influence of drugs,
reckless driving, or have a reinstated license in effect less than one year after revocation. [Required]
Valid input:
- Select only one choice.

[ ] Agree

I will not permit any unauthorized persons to drive the vehicle. [Required]
Valid input:
- Select only one choice.

[ ] Agree

While driving I agree to obey all traffic laws, agree not to drive under the influence of drugs or alcohol, agree not to possess or transport any alcohol,
illegal drugs, firearms or weapons. [Required]
Valid input:
- Select only one choice.

[ ] Agree

While driving I agree to wear a seat belt and require all passengers to wear a seat belt, and agree to avoid texting, horse play, racing, or other
distracting or aggressive behavior. [Required]
Valid input:
- Select only one choice.

[ ] Agree

Vehicle ownership
I will be driving... [Required]
Valid input:
- Select only one choice.

[ ] ... a private vehicle

[ ] ... a vehicle rented through LUC Campus Transportation

Rental Vehicle Information

Please upload your rental confirmation from LUC Campus Transportation here: [Required]

List the name, phone number, and emergency contact information for each passenger. [Required]

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Rental Liability
Terms & Conditions [Required]
I understand that by using a rented vehicle to drive myself and participants to this event/establishment, should there be any damage to my vehicle or injury to passengers in
my vehicle, that my rental insurance will be used to cover any claims made.

Neither the state of Illinois nor Loyola University Chicago, nor the Department of Student Activities & Greek Affairs will be responsible for damages or injury.
Valid input:
- Select only one choice.

[ ] I Agree

Personal Vehicle & Insurance Information

Make [Required]

Model: [Required]

License Plate Number: [Required]

Car Insurance Company: [Required]

Car Insurance Policy Number: [Required]

Car Insurance Policy Expiration Date: [Required]

List the name, phone number, and emergency contact information for each passenger. [Required]

Destination Information
Destination (Name of establishment and address) [Required]

Departure Date/Time [Required]

Return Date/Time [Required]

Private Liability

Page 2 of 3 · Driver Agreement Form

 Terms & Conditions [Required]
I understand that by using my personal vehicle to drive myself and participants to this event/establishment, should there be any damage to my vehicle or injury to
passengers in my vehicle, that my personal insurance will be used to cover any claims made.

Neither the state of Illinois nor Loyola University Chicago, nor the Department of Student Activities & Greek Affairs will be responsible for damages or injury.

I also affirm that my vehicle has current state inspection and registration.
Valid input:
- Select only one choice.

[ ] I Agree

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