Ukiah High SchoolUkiah Unified School District

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School Forms » Private Vehicle Use Forms

Private Vehicle Use Forms

UKIAH UNIFIED SCHOOL DISTRICT

PRIVATE VEHICLE USE FORM

 

As a driver of a vehicle, I understand that I must have:
1. A valid California driver’s license. Drivers with moving infractions within one year’s time of the court declaration date could be denied authorization to transport students. 
1.1. - UUSD only accepts a DMV printout (H4) for verification of driving record.
2. Required liability insurance on my car (specified in School Board Policy below):
2.1. - Each parent utilizing a private vehicle must show evidence of insurance carrying liability of a minimum of $100,000/$300,000 split limit or combined limit of $300,000. Evidence of insurance requires a photocopy of the coverage. (AR 402.6.3.b)
2.2. - Each parent utilizing a private vehicle must be informed that in the event of an accident, the parent’s insurance would be responsible for liability up to the limit of $100,000/$300,000 split limit or combined limit of $300,000. This District’s insurance will be liable for any amount in excess of the $100,000/$300,000 carried by the parent (not to exceed $1,000,000 limit of the District’s liability coverage). (AR 402.6.3.c)
2.3. - Permission and medical treatment forms must be carried in private vehicles for student passengers.
3. A vehicle in safe operating condition:
3.1. - Brakes are good; windshield wipers, head lights, tail lights, brake lights work; tires have adequate tread; operational seat belts are available and are worn by all passengers. (BP 608)
3.2. - Five passengers plus driver – transportation limit for 6 passenger sedan. Eight passengers plus driver – station wagon/SUV transportation limit. Beyond the above capacity requires a special driver’s  license (vans for 10-15 persons).
3.3. - Current Driver’s License Number:_____________________________________________
3.4. - Driver’s Vehicle License Number: _____________________________________________
3.5. - Vehicle Model and Year: ____________________________________________________
 
I understand that it is my responsibility to provide a copy of my DMV printout, a copy of insurance as specified in 2.1 above and this form completed and signed prior to the event.
 
I also understand that drivers shall not use tobacco products per Board Policy AR 402.6.3.d while transporting students.
 
I hereby acknowledge that as a driver providing my own vehicle, I have read and understand the information provided herein. My signature below hereby affirms that I fully accept and agree to the terms and obligations as stipulated.
 
PRINT NAME: _______________________________________________________________________________
Driver of Car
 

DRIVERS SIGNATURE:_________________________________________________

___________________

 

 

Date

SCHOOL NAME: _____________________________________________________________________________

FOR DISTRICT USE:      APPROVED  ☐

/ ☐ DENIED

 

 
REASON FOR DENIAL:_________________________________________________________________________________
 
___________________________________________________________________________________________________
 
PRINCIPALS SIGNATURE: ______________________________________________
 
 
___________________
 
Date
 
DISTRIBUTION: Signed original on file at School Site ~ Signed copy to Driver
 
 
~ Signed copy to Transportation
 
Z:\Personnel\Common\Forms\Private Vehicle Use Form.doc