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SafeRides 2011 Form

SafeRides 2011 Form

Used for saferides registration Form Preview
  • Student Pledge:

  • I agree in joining the SafeRides Venturing Crew, No.789 of the Connecticut Yankee Council of the Boy Scouts of America in Ridgefield, CT, understand my responsibilities: To know when I am working and to be there on the assigned night and time. If I cannot be there, I am to find another member of SafeRides as a replacement and notify my leader. I also understand that I will follow the rules developed by SafeRides of Ridgefield and I will not drink alcohol or use illegal drugs or be impaired in any fashion during the day or night that I am assigned to work at SafeRides.
  • Leave "Issue Date of Your License" Blank If You Do Not Have A License Yet

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  • The remainder of the application requires a parent/guardian. When your parent/guardian is ready to continue, please have continue below. By proceeding you are affirming under oath and penalties of perjury pursuant to Title 28 U.S.C. 1746 and other applicable statutes and laws that you are the parent or guardian of the minor who is enrolling in the Ridgefield Safe Rides Program.

  • Portion For Parents/Legal Guardians:

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  • Insurance Coverage For BSA Volunteers:

  • This coverage provides for the council, all Scouting professionals and employees, Scouting units, chartered organizations and volunteer Scouters with respect to claims arising in the performance of their duties in scouting. Coverage is more than $15,000,000 for bodily injury and property damage. The insurance provided Scouting volunteers through the BSA General Liability Insurance program is excess over any other insurance the volunteer might have to his or her benefit, usually a homeowner, personal liability or auto liability policy. There is not coverage for those who commit intentional or criminal acts.
  • All vehicles MUST be covered by a liability policy. The amount of this coverage must meet or exceed the insurance requirement of the state in which the vehicle is licensed. (It is recommended however, that coverage limits are at least $50,000/ $100,000/ $50,000.) Any vehicle carrying ten (10) or more passengers is required to have limits of $100,000/$500,000/$100,000 or $5,000,000 single limit. The council’s automobile liability insurance is excess of the insurance the owner of the auto carries, providing insurance protection above the limits carried on the auto up to the council’s limit.
  • Student Signature:

  • Parent/Guardian Signature:

  • Should be Empty: