SaMple. Form 8.23-1 School Board of Alachua County, Florida TRANSPORTATION DIVISION REQUEST TO TRANSPORT STUDENT(S) JOh1\ S ('1/.-/{ 10/ LCkcrD55~ St.; Go..:l\l$v;{le , FL Name of Driver: Address: Event: B l-I5 v Spn(~ L~C..ro5se B tiS Origin: IN PRiVATE VEHICLE 3 J- c 0 7 ' , I r Date of Event: I '-/). Go.~5 Destination:_v:-=--&'t---.-.:...r-=-;..::....:e-5~ Vo.r/ e5 Time of Departure: Coo. cl Faculty Sponsor: 5easoY\ _ Time of Return:---=-V,-=-4:.:...r_;-.:f!..:..;::,5=---_ R...e..e.J f<?J(116/cJS I request permission to transport student(s) in the following described private vehicle for this event: CheN ro(e,,+ Make -ro.~ if. Co.r Year (,,0+ OL) hie.Ree Number Model PL . I have personal injury protection and State "ea.:; property damage liability insurance currently in effect with It Be.. under -r:(lj(')'laflca. <-15 b? 81 /23 Company Name covering this Policy Number vehicle. The vehicle is in good working order. The student(s) will be transported only in designated seating positions, and I will require the student(s) to use the vehicle manufacturer's crash protection system (lap/shoulder belts). I declare that I have read the foregoing form and that the facts stated in it are true. Also - - - - G J!e~D CoPy - - - - - - - -- - E9 s/s « of ORr.vE.«'S txc c - -- -- - - - - --- - APPROVAL TO TRANSPORT APPROVAL IS GRANTED for the above-listed vehicle and for the event shown above. Date - o.ne! - AUTO -:t:.;J5()~A-/VCtf cirtO ----- - - -- --- - STUDENT(S) driver to transport student(s) in the private Principal's Signature Attach photocopy of driver's license, insurance I.D. Card and list of names of student(s) to be transported. Form No. TRN 089.001 New Date: 9/30/10 Distribution: White· School Administration Yellow - Driver