SAFE RIDES APPLICATION

ATTENTION:  Please fill out neatly and with care.
  This Application is a reflection of your desire to be a part of this
Program and will be looked at carefully. 
Read though the Application before filling it out. 

Name:_____________________________Date of Birth________Current Grade:_______

Address_________________________________________________________________

HomeTelephone # ___________________Student Email _________________________

Student Cell Phone # ______________________________

Parents Name(s)_______________________________ Parent Email ________________

Address______________________________________ Telephone__________________

(If different from above)

Drivers Only: (you do not need to be a driver to participate in Safe Rides)

  1. Drivers License Number_____________________Lic Issue Date _____________
  2. Please list any tickets and/ or accidents (PLEASE be honest)
  3. Are you and your passengers covered on your parent’s insurance policy? _______
  4. Are your parents willing to let you use the car for your Safe Rides Duties? ______
  5. Have you had your license for 6 months or more?___________

If not, when will you have?_____________________________

ALL APPLICANTS

Please answer the following questions typed in a short essay on a separate sheet

  1. Describe your motivation for joining Safe Rides?
  2. What are your thoughts on the purpose of Safe Rides?
  3. What are your thoughts on the subject of drinking and driving in general, and in Darien specifically?
  4. In your opinion, do you feel that Safe Rides may contribute to the problems of under-age drinking? Please explain.
  5. Please tell us one special characteristic about yourself?

 

 

      Safe Rides is open to all juniors and seniors whether or not the have a driver’s license.

      I realize that being a member of Safe Rides, Darien Red Cross, is a commitment, which I must take seriously.  In joining Safe Rides, I have made a commitment not to ever drive intoxicated, when on duty (as driver, rider, or dispatcher), or at any other time.  I will not knowingly transport alcohol or drugs while on duty.

     

      In addition to this, I willing am willing to keep confidential any and all Safe Rides information and agree to attend all training and general meetings.  I also understand that I must show up for all assigned nights on duty or find my own sub.  With my acceptance to Safe Rides, I understand that I am required to pay a one-time dues fee of $50.00, which includes umbrella insurance through The Darien Red Cross.   

      I recognize that the above commitments are vital to the success of the Safe Rides Program and should I fail to meet the commitment, I will be subject to suspension or expulsion from Safe Rides. 

      Applicant’s Signature_________________________________ Date___________

I recognize that the above commitment of my child is vital to the success of Safe Rides.  I give permission for my child to participate in the Safe Rides Program.

            Parent’s Signature____________________________________ Date___________

Safe Rides Officers:

 

Safe Rides Adult Advisors

Susan McDowell        656-2502                     Please return completed application
  by email to McDBrood@aol.com