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The Town of Fountain Hills is seeking adult volunteers with an excellent driving record who are
willing to use their personal vehicle to provide a ride to our most needy residents. This
application will be used to establish your eligibility as a volunteer driver for the Town of
Fountain Hills. The information you provide helps assure you, the town, and the residents that
the highest standards of safety and accountability are maintained. We appreciate your
cooperation and interest in our volunteer driver program, “Give a Lift”.
I fully understand, acknowledge, and agree to the following: the ‘Give a
Lift” volunteer driver program is under no obligation to accept all interested volunteers.
Any or all of the following may be required before placement as a volunteer driver with the
Town of Fountain Hills: a.) Background Investigation b.) Fingerprinting c.) Drug /Alcohol
Testing and d.) MVD Check. This release continues in effect as long as I continue to serve as
a Town of Fountain Hills volunteer driver.
As a volunteer, you decide your availability and choose the rides you wish to provide. There
is no minimum time commitment or number of rides required to be a volunteer driver.
All statements made on this application are true and authorization is given to investigate all
matters contained in this application. Any false statements or misrepresentation on this
application will be cause for refusal of placement or immediate dismissal at any time during
the period of my placement.
Enter your full legal name is required to submit this electronic form.
The purpose of the volunteer driver program “Give a Lift” is to provide safe and reliable transportation to and from essential services (medical facilities, grocery shopping, etc.) for homebound, ambulatory residents of the Town of Fountain Hills.
I understand that as a volunteer driver, I will be required to drive my personal vehicle and possess a valid driver’s license. I understand that the Town of Fountain Hills will request a copy of my driving record from the Motor Vehicle Department to verify that I have an acceptable driving record.
I will be required to provide proof of my automobile insurance coverage as indicated by the State of Arizona. In the event that my coverage changes or is cancelled, I will immediately notify the Town of such changes or cancellations. I understand that my personal automobile insurance will be the primary coverage. The Town of Fountain Hills does carry excess auto liability.
I am physically capable of driving my vehicle safely and will not drive while using any drug that may affect my driving ability, either prescription or ‘over-the-counter’. My vehicle is mechanically sound and equipped with seat belts which the riders and I will use.
I will protect the rider’s right to confidentiality. I will also respect their right to pursue an independent lifestyle, and be non-judgmental in my interactions with them.
I will schedule transportation with the volunteer assigned to me and understand that I have the flexibility and option to provide rides or not with all requests.
I will notify the Volunteer Coordinator with the Town of Fountain Hills at the time I no longer wish to participate in the program. Either the Town, or I, may terminate this agreement at any time.
Please read this form carefully and be aware that in participating in the Town of Fountain Hills Give-A-Lift Program, you will be waiving and releasing all claims for injuries you might sustain arising out of said program.
I recognize and acknowledge that there are certain risks of physical injury to participants in the Give-A-Lift Program and I agree to assume the full risk of any such injuries, damages or loss regardless of severity which I may sustain as a result of participating in any activities connected or associated with the Give-A-Lift Program. I waive and relinquish all claims I may have against the Town and its officers, agents, volunteers and employees as a result of participating in the Give- A-Lift Program. I hereby fully release and discharge the Town and its officers, agents, volunteers and employees from any and all claims from injuries, damage or loss which I may have or which may accrue to me on account of my participation in the Give-A-Lift Program. I further agree to indemnify and hold harmless and defend the Town and its officers, agents, volunteers and employees for, from and against any and all claims resulting from injuries, damages and losses sustained by me and arising out, connected with, or in any way associated with any activities of the Give-A-Lift Program.
I have read and fully understand the Give-A-Lift Program details and waiver and release of all claims.
This field is not part of the form submission.
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