Volunteer Driver Form

In order to provide for the safety of those we serve, we must ask each volunteer to complete this form.

Name*
First Middle Last
Address*
Street Address City State ZIP Code
Driver's license number*
State issued*

Type the state where your driver's license was issued.
Year, Make & Model of Vehicle:*

Please enter the year, make, and model of the vehicle you will be driving (example: 2017 Toyota Camry)
Liability Limits*

(Minimum Limits of $100,000/$300,000 Required)
I have NOT had a conviction for an infraction involving drugs or alcohol (such as driving under the influence or driving while intoxicated) in the last three years.*
- True
- False
I have NOT had two or more convictions for an infraction involving drugs or alcohol (Such as driving under the influence or driving while intoxicated) in the last seven years.*
- True
- False
I have had no more than three moving violations or accidents in the last three years.*
- True
- False
I certify that the information given on this form is true and correct to the best of my knowledge. I understand driving for the National Association of Catholic Chaplains is a profound responsibility and I will exercise extreme care and due diligence while driving. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration and have the required insurance coverage in effect on any vehicle. I agree that I will refrain from using a cell phone or any other electronic device while operating my vehicle.*
- I agree
If you agree to the statement above, check the "I agree" box below, then enter your name and today's date below that. This constitutes your signature on, and agreement with the information supplied on, this Volunteer Driver Form.

Once you complete the form above, you will be redirected back to the Interviewer Materials Page.

Please be aware that as a volunteer driver, your insurance is primary.
Thank you for helping us with our transportation needs!

If you haven’t already, your next step should be to complete the Driver Acknowledgement Form.
Click here to go to that form.

If you have completed both forms, click here to return to the NACC Certification Interviewers’ Materials Page.

Volunteer Driver Form

Volunteer Driver Form

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Volunteer Driver Form

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