WELLSMIDDLESCHOOL

“Home of the Roadrunners”

A California Distinguished School

Dear School Volunteer:

Volunteers provide key support for our students. Thank you for your interest in volunteering at our school. The Dublin Unified School District has implemented an annual screening process for all that wish to volunteer their services.

The purpose of this annual screening is to ensure that no one working with our children has a record of sexual misconduct, thus providing a safe and positive environment in our classrooms and activities. Once it has been determined that the potential volunteer has not been identified on the Megan’s Law list, the principal or designee will approve your request to volunteer.

For drivers:

  1. The Dublin School District carries liability insurance covering all school-sponsored activities. In the event of a vehicular accident, however, coverage is provided by the volunteer driver’s own automobile insurance.
  1. The school district does not provide insurance coverage should a vehicular accident occur while a volunteer driver is transporting students.
  1. Volunteer drivers must be at least 21 years of age and must possess a current, valid California driver’s license to operate this vehicle.
  1. Volunteer drivers certify that their vehicle is in safe operating condition.
  1. Volunteer drivers and/or the owner for the vehicle have primary responsibility for liability. The liability insurance of the volunteer drivers will be deemed the primary liability insurance for claims purposes.
  1. Volunteer drivers agree to dive in a safe and cautious manner and to notify the school district immediately in the event of accident or injury of any type.
  1. Volunteer drivers shall have a first aid kit in their possession, or immediately available.
  1. Volunteer drivers will carry no more passengers than their vehicle is designed to carry. In no case may a volunteer driver carry more than eight passengers plus the driver.
  1. Volunteer drivers offering to provide transportation for students for one or more school sponsored field trips during the school year acknowledge their responsibilities as indicated in this notice and will acknowledge receipt by signing and returning a copy of the notice.
  1. The District reserves the right to decline offers of assistance from parents, guardians, and other volunteers, including but not limited to driving.
  1. Volunteer driver, by their signature on the Transportation Authorization Form, waive all claims against the District for injury, accident, illness, or death occurring during or by reason of the field trip.
  1. Volunteer drivers shall defend and indemnify the District against all claims, actions, or lawsuits arising out of the negligence of the volunteer driver.

Thank you for your cooperation, understanding and support of the District’s desire to keep our students and school safe.

Insurance Expiration Date: ______Copy of CDL Attached

Proof of Insurance Attached

DUBLIN UNIFIED SCHOOL DISTRICT TRANSPORTATION OF

STUDENTS IN PRIVATELY OWNED VEHICLES*

Certificate and Authorization for PARENT/GUARDIAN(S)*

WELLS MIDDLE SCHOOL

I have agreed to use my privately owned automobile for transporting students to school related activities. I certify that I possess a valid California Driver’s License and presently have in force, automobile liability insurance coverage. I also accept the terms of the Indemnity Provision stated below.

Names(s) of DUSD Students: ______

Name of Driver: ______Driver’s License No.: ______

Address of Driver: ______Main Phone No.: ______

Make of Automobile: ______Year/Model/Style: ______

Automobile License No.: ______Passenger Capacity w/Driver: ______

Name of Insurance Company: ______Policy No.: ______

SEAT BELTS REQUIRED TO BE USED BY ALL OCCUPANTS
(NEW LAW AS OF JANUARY 2012)
ALL STUDENTS MUST BE AT LEAST 4 FOOT 9 INCHES TALL or 8 YEARS OF AGE

OR THEY MUST BE PLACED IN A CHILD BOOSTER SEAT

STUDENTS UNDER THE AGE OF 12 ARE NOT PERMITTED TO RIDE IN FRONT SEAT IF AIRBAG IS INSTALLED IN VEHICLE

PLEASE ATTACH A COPY OF INSURANCE COVERAGE DECLARATION PAGE TO THIS FORM

I have met the minimum insurance requirements per

occurrence as listed below or have umbrella coverage

of at least $500,000:

Bodily Injury Liability (BI):

Each Individual $100,000

Total Each Accident $300,000

Property Damage Liability (PD):

Total Each Accident $25,000

or Combined Single Limit (BI & PD): $300,000

Medical Payments:

Each Individual $5,000

Uninsured Motorist Coverage (UIM):

Each Individual $100,000

Total Each Accident $300,000

Parent/guardian(s) should be aware that although there is a liability insurance policy in the District, it is the individual driver’s own auto liability insurance that must provide the coverage in case of an accident. See Insurance Code 11580.1.

Please obtain a Report of Accident form from school office prior to departure.

* INDEMNITY PROVISION *

Student drivers shall not transport other students on authorized field trips.

The owner/driver agrees and accepts his/her obligation to operate, manage and control his/her vehicle in a safe and lawful manner while transporting students, pursuant to this certificate and authorization.

The owner/driver further agrees to defend and indemnify the Dublin Unified School District from any claim, action or lawsuit brought by anyone which arises out of, or is in any way connected to the operation of the vehicle, pursuant to this certificate and authorization.

______Date ______Signature of Owner/Driver

DUBLIN UNIFIED SCHOOL DISTRICT

Volunteer Information Form

Authorization for Parent/Guardian

WELLS MIDDLE SCHOOL

California Education Code Section 35021 requires school districts to screen school volunteers. In order to complete the screening, please provide the information requested below.

Name of Student ______

Name of Volunteer ______

LastFirstMiddleOther Name

Address: ______City/Zip: ______

Telephone: ______Telephone: ______

HomeWork or Cell

Date of Birth: ______Driver’s License #: ______or State ID #: ______

(attach photocopy) (attach photocopy)

EMERGENCY CONTACT

Name: ______Relationship: ______Phone/Cell #: ______

Name: ______Relationship: ______Phone/Cell #: ______

REFERENCES(List 2 people who are not related to you who have knowledge of your character or work experience)

Name: ______Relationship: ______Phone/Cell #: ______

Name: ______Relationship: ______Phone/Cell #: ______

FOR COLLEGE STUDENT VOLUNTEERS

______or ______

College/University NameCollege/University IDVerification of Enrollment

I agree and understand that it’s my responsibility to notify the school administration of any status change in my driver’s license if I volunteer to drive. The approval to volunteer will be based on the clearance of the background check on Megan’s Law list and approval of the principal or designee.

Signature ______Date ______

TO BE COMPLETED BY SITE ADMINISTRATOR/DESIGNEE

Volunteer Assignments Cleared for:

Classroom volunteer School Activities/Fundraisers Other

Driver* Outdoor Education/Overnight **

Certificated Supervisor: ______Date: ______

Principal/Designee: ______Date: ______

* Driver clearance requires submission of valid copy of driver’s license, proof of current auto insurance which reflects driving record,

i.e points; OR valid copy of driver’s license. Driving records with more than one point will not receive clearance to drive. Drivers will

need to complete the Transportation of Students Authorization Form attached.

** Activity requires Livescan fingerprint clearance.