Boulder Valley School District


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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:    _________________________________________________

Date:    ____________________________________________________________________
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.