Driver Insurance Verification Form

I desiring to participate with the above named club, understand that I am required to have automobile insurance coverage prior to driving to any Sports Club activity.

The student's signature alone is adequate if the student is 18 years of age or older.  If the student is under 18 years of age, this form must be co-signed by a parent or guardian. 

Automobile Insurance Carrier & Policy Number Expiration Date
For individuals under the age of 18 a paper copy of this form must be picked up at the recreation office and signed by a parent or legal guardian. The form must then be returned to the recreation office prior to participation in any Campus Recreation program or activity.By Signing this form I verify that I have the insurance listed above and will keep said insurance in force while participating on a Sports Club.Furthermore I am of legal age (18 or over) to sign this form.I accept [  ]