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CHRIST THE KING CATHOLIC SCHOOL |
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DRIVER’S INFORMATION |
Date : |
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Driver’s Name: |
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Place driver’s license here before copying |
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Vehicle Information: |
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License Plate #: |
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Make of vehicle |
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Model of vehicle: |
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# of Seat belts (including the driver’s |
*Please make note of any restrictions listed on the back of the driver’s license.
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Insurance Information
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Insured |
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Insurance Company |
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Policy # |
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Insurance Company’s # |
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Agent |
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Agent’s # |
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Coverage Effective Date |
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Expiration Date |
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Type or Amount of Coverage |
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Emergency Contact Information
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1st Emergency Contact |
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Daytime Phone # |
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Relationship |
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Additional Phone # |
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2nd Emergency Contact |
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Daytime Phone # |
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Relationship |
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Additional Phone # |
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