St. George’s Episcopal Church, Arlington, Virginia

A Diocese of Virginia parish serving God in Arlington, Virginia, since 1908; on the net since 1998
Our mission: to make God known.

Motor Vehicle Info

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St. George’s Youth Field Trip
Motor Vehicle Information
Group:  ______________________________ Sponsor:  _____________________________
Date:  _______________________________ Phone:    ______________________________
Activity:  ___________________________________________________________________________

____________________________________________________________________________________
The following vehicles will be used to provide transportation for this field trip:

Kind, Year, and Make of Vehicle

Owner’s Name

Driver’s License Number

Number of Passengers

Number of Seat Belts

Public Liability $/Person

Public Liability $/accident

Property Damage
x x x x x x x x
xxx xx xx xx xx xx xxxxxv xx
xxx xx xx xx xx xx xxxxxv xx
xxx xx xx xx xx xx xxxxxv xx
xxx xx xx xx xx xx xxxxxv xx
 

As the sponsor of this field trip, I pledge that:

  1. All drivers will use reasonable travel speed in accordance with state and local laws.

  2. All drivers have a valid driver’s license.

  3. Driving time on extended field trips is limited to a maximum of 10 hours and will be interrupted by frequent rest, food, and recreation stops.

  4. Seat belts are provided and will be used by all passengers and drivers.

  5. Passengers will ride only in the passenger compartment of trucks or station wagons.
     

______________________________________

________________________

(Signed by Sponsor)

(Date)
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