FIELD TRIP DRIVER'S LICENSE
AND VEHICLE INSURANCE INFORMATION
VEHICLE INSURANCE INFORMATION
(required when transporting students on field trips
in personal or leased vehicles)
FS-142 (12/17)
meets Federal Motor Vehicle Safety Standards and state standards applicable to passenger
has a certified seat and seat belt for each passenger (owner- or dealer-installed seats and/or seat belts are not certified)
is designed and manufactured to transport fewer than ten passengers
Information on the driver and the driver's liability insurance is required for all personal and leased vehicles used to transport students
(not applicable for school bus or commercial bus drivers or vehicles). This is an official FCPS document. Any falsification or
misrepresentation may lead to disciplinary action for FCPS Staff or liability exposure for other drivers.
FIELD TRIP PLAN
(to be completed by the trip organizer)
DRIVER AND INSURANCE INFORMATION
PART I. DRIVER
Specific Trip
Name
Repeated Trip
Date Explain
Destination
Purpose
I certify that the vehicle I will use for this field trip:
Date
Model
Driver Signature
Owner or Lessee of Insured Vehicle
PART III. INSURANCE
Insurer
Vehicle Make
Owner or Lessee Signature Date
SCHOOL PRINCIPAL APPROVAL
Principal Signature Date
car occupant protection standards (at the time the vehicle was manufactured)
Student Parent Teacher or Staff Member (Part II required) Other
Operator License Number State Expiration
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