Volunteer Driver Form Beenleigh & District Baptist Church Please complete if you are providing transport during Youth Group activities. All drivers must have an OPEN Licence and hold a current Blue Card if transporting children or young people. Driver's Name: Your email: Mobile Phone: Emergency Contact Name & Phone Number: Car Registration Number: Driver's Licence Number: Licence State of issue: QLDNSWVICSAWANTACTTAS Licence Expiry Date: Type of licence: CarBusOther If other, please specify: Number of years driving experience (minimum 3 years): Blue Card required? yesno If yes, Blue Card Number: Blue Card Expiry Date: Do you have any restrictions on your licence, e.g., night driving, or a medical condition and/or medications which may affect your ability to drive safely? yesno If yes, please specify: Witness to complete: Licence sighted by: Email of Witness: Declaration: I have completed all screening requirements for the organisation, in relation to my suitability to work with children. I will drive carefully and follow the road rules when driving on behalf of Beenleigh Baptist Church. I will provide a registered, roadworthy vehicle. I will ensure that all passengers wear a seat belt. I will not drive under the influence of alcohol or drugs or permit smoking in the vehicle. I will not transport only one child unless he/she is my own child. (Transporting all other children requires a current Blue Card) I have a good driving record. I have not committed traffic offences in the recent past, which preclude me from transporting participants. If unsure, I will discuss this with my team leader prior to offering myself to drive. I acknowledge that this information is correct and indicates my commitment to the safety and welfare of those for whom I am responsible. YesNo WPS-02 January 2022 Δ
