Changed Lives...Changing Our World...On Purpose

VAN USE FORM

Name:

Member?

YES
NO

Phone #:

Ministry:

# of people expected:

Explain Purpose and Destination of Trip:

Departure Date:

Departure Time:

Return Date:

Return Time:

Key Pick-up Location:

Church
Weston's Mobile

A copy of your license must be on file with the church before you can drive the van.

Maine License#:

Exp. Date:

Any accidents in the past 5 years?

YES
NO

If 'YES' please explain below:

Experience driving a 15 passenger van?

YES
NO

I agree to follow the guidelines listed in the Policy and Procedure for Van Use. I also confirm that all of the above information is accurate and true.

Signed:

Date:

Email Address:

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Changed Lives...Changing Our World...On Purpose

VAN USE FORM

Know Jesus?