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.
Office of Student Activities is located in room 258 of the second floor of Templeton Campus Center on the Undergraduate Campus.
Director of Student Activities Jason Feiner
Office of Student Activities
0615 S.W. Palatine Hill Road, MSC 187 Portland, Oregon 97219