Passenger Permission and Indemnity Form – Nazareth Catholic Community

Student Driver – Passenger Permission and Indemnity Form

"*" indicates required fields

This form is to be completed by the parent/caregiver

The purpose of this form is for parents / caregivers to provide permission for their child to be a passenger in a vehicle driven by another Nazareth student.

Students are provided with permission to carry other passengers for the journey to and from school or in between campuses during the school day only. Students are not permitted to drive either themselves, or other students, to school-related activities during the day that are not held on a Nazareth campus.

When submitting a Student Driver Application Form, student drivers agree to abide by the Student Driving Policy, and sign a Student Driver Declaration. The Policy and Declaration are linked below for your reference:

Student Driving Policy and Driver Declaration

STUDENT DETAILS

I give permission for my son/daughter as listed on this form, to be a passenger in the car driven by the Approved Driver listed below.

I release the Nazareth College Board and Catholic Church Endowment Society Incorporated (The College) from any liability arising from or in connection with such transport arrangements.

I indemnify the College from any loss or damage suffered by it or liability incurred to any person by it in connection with such transport arrangements

First Name*

Last Name*

Student Email Address*

Enter Email Confirm Email

Please only use the student’s Nazareth email address.

Year Level*

Mentor Group*

APPROVED DRIVER DETAILS

Driver First Name*

Driver Last Name*

Vehicle Colour*

Vehicle Make and Model*

Registration Number*

PARENT/CAREGIVER DETAILS

First Name*

Last Name*

Contact Number*

Parent/Guardian Email*

Enter Email Confirm Email

PARENT/GUARDIAN DECLARATION

Parent / Caregiver Signature*

Date of form completion*