- Support Services
File: EEAE-E (pdf)
Sponsor: ______________________________________ Name of Driver: _________________________________
Date of Trip: ___________________________________
Student Transportation in Private Vehicles
Boulder Valley School District does NOT insure school related trips in private vehicles. The district does not carry insurance on private vehicles driven by parents or volunteers. It is Board Policy (EEAE) and therefore required that the owner carry a minimum of the following: $100,000/$300,000 liability, $50,000 property damage and Uninsured Motorist $25,000/$50,000.
Board Policy EEAE is on the back of this form. Please read carefully before completing form. Thank you.
Model/Year of Car: ___________________________________________________________
Insured by: _________________________________________________________________
Liability Coverage ($): ________________________________________________________
Property Damage Coverage ($): _________________________________________________
Seat Belts: Yes____ for # _______ Passengers No _______ (unable to drive)
Maximum number of passengers: ___________ *ALL PASSENGERS MUST WEAR SEATBELTS*
Valid Driver’s License Number: ________________________________________________________
Current proof of insurance coverage must be submitted with this form. Please bring a copy of the declarations page of your insurance policy. Driver unable to drive without proof of coverage.
As a driver for field trips during the school year_____to_____, I understand that the district carries no insurance for private vehicles or students or drivers. I am personally responsible. I also certify that I am at least 21 years of age.
Driver Signature: ___________________________________________________________
Sponsor Signature: _________________________________________________________
Principal Approval/Signature: _________________________________________________
Please provide a copy of insurance policy or paperwork that indicates above dollar amounts of coverage (proof insurance card does not show dollar amounts.) We also need a copy of each driver’s license and a signed copy of the BVSD Volunteer Agreement (non-coaching).
*New law as of 8/1/10: Children under the age of eight shall be properly restrained in a child restraint system, according to the manufacturer’s instructions.