Student Driver Form

Student parking for Covenant students require a student parking permit.  General parking is in Chapel Rock parking lot. Cost is $17 for school year.  Senior parking is in the lot adjacent to the faculty.  Cost is $27 for school year.

Please complete the form below in its entirety.

Personal Info

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Have you been in an accident in the last three years? *
Have you been ticketed for a moving violation within the last three years? *
Have you ever been convicted for DWI/DUI of alcohol or drugs, or had your license suspended for moving violations, hit and run, eluding an officer, reckless or negligent operation of a vehicle, or driving while under suspension or revocation? *
Are you licensed to drive a commercial vehicle? *

Car #1

CCHS requires volunteer drivers to have the following minimum amount of liability insurance: (1) $100,000 liability per person for bodily injury; (2) $300,000 liability per incident for bodily injury for all vehicle occupants; (3) $100,000 liability for property damage.

Do you have uninsured/underinsured motorist coverage? *

Car #2 (if applicable)

Do you have uninsured/underinsured motorist coverage?

General Info

Please check the boxes next to the following items:

Signatures

The information given on this form is true and correct to the best of my knowledge.