Willow Glen Bible Church

Single Use Volunteer Driver Form

THIS FORM IS INTENDED FOR PERSONS WHO HAVE RESPONSIBILITY TO TRANSPORT MINORS IN THEIR PERSONAL AUTO FOR A SINGLE EVENT WHEN TIME OR CIRCUMSTANCE PRECLUDES COMPLETING THE NORMAL VOLUNTEER DRIVER PROCESS.

If you would prefer to fill out a paper form and hand it in to the WGBC office staff, use the button below.

Single Use Volunteer Driver Form PDF

First Name

Last Name

Phone Number

Address 1

Address 2

City

State

Zip

Date of Birth

Driver's License Number and State Issued by

Driver's License Expiration Date

Have you been in an at-fault accident or been ticketed for a moving violation in the past 3 years?Checkboxes
Yes
No

Has your driver’s license ever been suspended or revoked?
Yes
No

If you answered yes to either of the above questions please explain the nature of the charges?

Vehicle Model/Year

License Plate Number

Number of working seatbelts

Insurance Company

Policy Number

Policy Expiration Date

The church recommends volunteer private vehicles to have a minimum amount of liability insurance. (1) $100,000 liability per person for bodily injury; (2) $300,000 liability per incident for bodily injury for all vehicle occupants; and (3) $50,000-$100,000 liability for property damage.

I understand that in case of any accident, injury, or vehicle damage, the church’s liability insurance policy does not provide primary or direct insurance on my vehicles. The church’s insurance is secondary only after my personal auto insurance limits are exhausted for liability, damage to other vehicle, and medical, and does not provide any property damage, uninsured motorist, comprehensive or collision coverage on my vehicles(s). Damage to any private vehicle is the responsibility of the vehicle owner.

To my knowledge, my vehicle has a current, valid registration and operating license, is in safe operating condition (brakes, tires, etc.), and complies with all applicable state laws of California.

I am in good physical and mental health, it is safe for me to drive and neither my driver’s license nor my ability to operate a vehicle is limited by any medical, physical, or emotional restriction or condition

I am at least 21 and not over 75 years old, and have a good driving record with at least five (5) years of extensive driving experience.

Seat Belt Usage—I agree to transport persons only in passenger seats equipped with appropriate seat belts and child safety seats. I agree to require seat belt usage and child safety seat usage at all times.

I affirm that I will carefully transport all persons under my care, including obeying all traffic laws and the church transportation policy.

I, the undersigned, give my authorization to WGBC representatives to verify the information on this form. I further request the reporting agency to release to WGBC representatives information which pertains to any record of convictions or driving records contained in its files or in any criminal or motor vehicle file maintained on me whether local, state or national. I hereby release the said agency and Willow Glen Bible Church from any and all liability resulting from such disclosure.

Typing my Name is my signature

Date

Submit

Limitations

This form is for every person loaning a vehicle to WGBC to use for ministry events.

This form is also for use by WGBC ministry leaders to authorize drivers to transport minors to local events when there isn’t time to fill out a regular WGBC Driver Application. For example, an impromptu ice-cream run is organized after a Jr. High meeting and several parents are asked to each drive several kids in their car. Another example would be the case when an authorized WGBC driver is scheduled to drive for a local event and drops out at the last minute—if no other authorized drivers are available, a substitute driver could fill this form out and drive instead. “Local” is anything within a 15-mile radius of the church.

All drivers will be subject to verification of their motor vehicle driving record.

Disqualified Drivers

Persons with convictions or suspensions for reckless, careless, or negligent driving; grand auto theft; hit and run; multiple moving violations; eluding an officer; or unlawfully leaving the scene of an accident as well as persons who have been convicted of, placed on regular or deferred adjudicated probation for, received pre-trial diversion for, or pled guilty or nolo contender to the following offenses: manslaughter, criminally negligent homicide, consumption or possession of alcoholic beverage in a motor vehicle, driving while intoxicated, or any other intoxicated offense, including but not limited to intoxication assault, intoxication manslaughter, and any drug possession or use charge or excessive moving violations, will be disqualified to drive the church vehicles or to transport minors to/from church-sponsored activities in the personal vehicles.