Driver & Vehicle Information:

Owners Name_____________________________________________

Address__________________________________________________

City, State Zip_____________________________________________

Driver’s license number____________________Renewal Date_____

Telephone no.__________Cell no.___________Email_____________

Insurance company________Amount of Liability Coverage________

Other drivers of same vehicle (this trip only) and driver license number:

_____________________________  _____________________________

_____________________________  _____________________________

Make of Vehicle______________________________________________

Model Year_____Color__________Auto license no.______________

Basic Safety Check                                       Additional Safety Check

1. Seat Belts for every passenger?____  1. Flares for emergency? ___
2. Tire tread OK? ____ Spare OK?____   2. Fire extinguisher? ____
3. Jack OK? ____  Brakes OK? ____        3. Flashlight? ____
4. Windshield Wiper works? ____            4. Tow chain or rope? ____
5. Fluid reservoir filled? ____                     5. First-Aid kit? ____
6. Headlights and Turn Signals OK? ____
7. Rerview mirors? ____
8. Exhaust System OK? ____                                   Top of Page!                                                                                                         

[1st Baptist Church, Little Ro ck, Troop 55] [Calendar] [Adult Leaders] [BSA Advancement] [BSA Aims] [BSA Boy Leaders] [Lord Baden-Powell] [BSA Values] [Faith] [Fun] [Orienteering Page 1] [Guidelines] [Patriotism] [Safety] [Driver & Vehicle Information] [Street Wise] [Tabs for Notebook] [Web] [Scout Outing Forms] [Troop  Master Forms]