Personal Vehicle Registration

* = required field

CARLETON COLLEGE SPORT CLUB PROGRAM
REGISTRATION OF PERSONAL VEHICLE FOR OFFICIAL TRAVEL FOR THE CLUB SPORT PROGRAM
Name of person using a personal vehicle (print):*
Club:*
DRIVER OF VEHICLE:
Birth Date:*
Student ID #:*
DRIVERS LICENSE:
State:*
Number:
Date Expires:*
VEHICLE:
Year/Make/Model:*
License Number:*
Owner:*
VEHCILE INSURANCE:
Company:*
Policy Number:*
I hereby certify that I am 18 years of age, that I currently hold a valid driver’s license, that I have not been convicted of a major traffic violation with the past 36 months, that as long as I use my vehicle for Club Sport business I will keep the above insurance (or equivalent) in force, and that all of the above statements are true. I am aware that in the event of an accident, my vehicle insurance is primary.
In addition to filling out this form, I will complete the following online Driver Safety Training.
Instructions: United Educators Driver Safety Training To access the Driver Safety course, learners need to follow the UE’s Learning Management System (LMS) web link listed below and enter the registration code that validates eligibility to take the course. Once the registration code is accepted, learners can register for and take the courses. 1. Go to www.edurisklearning.org to register with our institution code which is listed below. 2. First-time users should select the link to create a new account on the right side of the screen. a. Use this institution registration code: 0916-SE37-XY12 b. Provide specific information about your role at the institution (ex: athletics personnel, student, etc.) c. Use your Carleton ID, on the back of your OneCard as your ID number. d. and then create a username and password. 3. Use your username and password each time you log into the LMS using the link provided in step 1. 4. To enroll, click Get Started under Driver Safety. Then click on Course DS-101-H Driver Safety Training (2016-2017). You can complete the course in sections and it will pick up where you left off. The United Educator’s site will give us a report of who completed the course and you can also print off a certificate for your own records.
Legal Name:*
Signature:*
Date:*
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