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Vehicle Owner/Driver Acceptance of Responsibility Form

Please complete this form if you plan on driving your personal vehicle for any activity for your student organization. Please note that drivers must be cleared by Facilities Service in order to be eligible for reimbursement for mileage and/or gasoline.

As the insured owner/driver of the vehicle listed below, I understand and will adhere to all “rules of the road,” and will adhere to the policies with regards to travel identified by Lewis & Clark College. I also acknowledge that Lewis & Clark College does not provide insurance for the vehicle and/or its owner, driver, or occupants and is not liable for personal injury or property damage. As the owner/driver of the vehicle listed below, I understand that I may be exposing myself to personal liability in the event of an accident.

Please enter today's date.
Please enter your full name.
Please enter your cell phone number.
Please enter your L&C email address.
Please enter the state that your driver license is from and its number.
Please enter the name of the company that your car insurance is from.
Please enter your insurance policy number(s).
Please enter the make for your vehicle.
Please enter your vehicle's model.
Please enter the state that your vehicle is from and its licence plate number.

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