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Vehicle Request

2. 
4. Organization/Individual*
5. Today's Date*
   Today's Date
7. First Name*
8. Last Name*
10. Address*
12. City*
13. State*
14. Zip*
16. Phone*
17. Email*
19. Vehicle Needed*

    1. White Bus
    2. Blue Bus
    3. Mini Bus
    4. Van
20. Driver's Name*
21. CDL*

    1. Yes
    2. No
23. Trip Destination*
24. Number of Passengers*
26. Day Requested*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
27. Date Requested*
    Date Requested
28. Time Requested*
    Time Requested Start Time

    —

    Time Requested End Time
30. Transportation waiver for use of DRC Bus or Van

    1. I accept

    In consideration of your accepting this entry, I hereby, for myself, my organization participants on this trip, our heirs, executors and administrators, waiver and release any and all rights and claims for damages I or trip participants may have against the Derby Recreation Commission, City of Derby, or USD 260, and its representatives, successors and assigns for any and all injuries suffered by myself or trip participants on any trip taken by my group on the Derby Recreation Commission Bus or Van. It is hereby agreed and understood that all approved applications for the use of the DRC bus/van and/or equipment shall be subject to the conditions of all DRC policies. This includes the suggested donation for the bus or van.
32. CLASS updated
33. Rental Number
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field