EEBB-R(2) permission form for transporting students

The Board allows staff to use private vehicles for school purposes to conduct school business and to transport students to school sanctioned activities. This form must be completed and on file in the Superintendent's office prior to employees transporting students under this policy.

Please complete the following form:

Name of Employee: _________________________________________________________________

Driver's license number: ___________________________________, valid until: _________________

Do you affirm that you carry a minimum liability insurance of $100,000/$300,000, minimum property damage insurance of $50,000 and a minimum medical coverage of $5,000. Yes____ No____

Do you have insurance against unlicensed motorists: ______________________________________

Do you affirm that your vehicle has a current legal inspection sticker and is currently registered in the state of Maine?

Do you affirm that you have seat belts for all occupants that will be riding in your car and affirm that you will insist that seat belts are worn at all times the vehicle is moving?

_______________________________________ __________________________________

Signature of staff member Date

Approval is given for this staff member to use private vehicle after meeting the above requirements for student/staff transport for sanctioned school events or activities.

_______________________________________ ___________________________________

Superintendent Date