Vehicle Reservation Form, Public Safety

Vehicle Reservation Form

This form must be submitted prior to the date of the trip in order to confirm your vehicle reservation.

If your requested drivers have not had their licenses registered with the Department of Public Safety, it must be submitted and approved before they drive the vehicle.
College vehicles are not for personal use or any purpose other than that authorized above. Insurance may not cover vehicle/passengers if it is used for another purpose.
The driver(s) agree to obey all traffic laws governing use of motor vehicles. Driver(s) are personally responsible for any fines or charges incurred for violation of laws.
If gasoline credit cards are issued, the driver(s) are personally and financially responsible for their use.
For trips outside of the Richmond/Wayne County area, a list of passengers is required before departure. Emergency contact numbers must also accompany the list.
For those traveling outside the Richmond/Wayne County area, it is important that a cell phone be available for emergency communication. The cell phone number must be listed on the passenger listing.

Contact Information

Full Name *

Email *

Phone *

Number of Vehicles Needed

Cars

Minivans

12-Passenger Vans

Special Needs or Requests

About Your Trip

Date of Vehicle Pick-up *

MM-DD-YEAR (i.e., 03-15-2013)

Time of Vehicle Pick-up (include am/pm) *

Date of Vehicle Drop-off *

MM-DD-YEAR (i.e., 03-15-2013)

Time of Vehicle Drop-off (include am/pm) *

Destination *

Number of Passengers

Purpose of the Trip *

Account Number *

Faculty Member Approval

Faculty Name *

Department *

Faculty Email *

Campus Phone *

I affirm the person(s) listed as driver(s) to be reliable and qualified. *

Yes

I give approval of this trip as being in the interest of Earlham College. *

Yes

I have reviewed with the driver(s) the Campus Policies with respect to all passengers on this trip. *

Yes

Drivers and Faculty

Driver #1 Name *

If driving a 12-passenger van, has driver #1 taken the Coaching the Van Driver course? *

Yes
No

Driver #2 Name

If driving a 12-passenger van, has driver #2 taken the Coaching the Van Driver course?

Yes
No

Is a faculty/staff member going on the trip? (Required for trips greater than 100 miles) *

Yes
No

Faculty/Staff Member's Name