EEAE-AR - Proof of Auto Liability Insurance**

Adopted: Unknown
Re-adopted: 12/4/01

Dear [     ],

You have agreed to transport        students of the district to a field trip function or for some other school approved purpose.  It is our understanding that you are equipped to transport them all in appropriate, seat-belted positions in your private automobile.  Please be aware that in the event of an accident, your insurance may be the primary source of coverage.

Please provide the following information for our records and as evidence of required insurance coverage.


Driver’s Name:                                                                                                 Date of Birth:                   

Insurance Company Name:                                                                         Effective Date:                 

Policy Number:                                                                                      

Oregon Driver’s License Number:                                                    



Signature of volunteer verifying the above information as true and complete.