MSBC Van Requisition Form

Name

This address will receive a confirmation email

Phone

Date of Application

What group or ministry will be using the van?

Cliff Youth Group Men's Ministry Women's Ministry Campus Ambassadors AWANA Young Disciples Other

What is the destination and purpose for the use of the van?

Date of Planned Van Use

Planned Departure Time

If overnight trip when do you plan to return?

What time to do you expect to return?

The van can hold 12 passenders including driver. How many passengers will there be?

Are their waivers on file for all minor passengers?

Yes No minors on van for trip

All drivers MUST be on the approved MSBC driver list. Drivers signature will be required when picking up keys and credit card. The Primary Driver is responsible for the replacement cost of lost van key and/or lost credit card.

Primary Driver Name

Name of Emergency Contact for Primary Driver

Phone number of Emergency Contact for Primary Driver

Assistant Driver Name

Name of Emergency Contact for Assistant Driver

Phone number of Emergency Contact for Assistant Driver

Other drivers for trip?

Phone numbers of Emergency Contacts for Other Drivers

Description

Please fill out this form and click submit. When picking up the keys for use of the van a supplemental form will need to be signed and a van trip sheet will be given to be completed and returned when trip is completed.

MSBC Van Requisition Form

Description

Please Fix the Following