STUDENT DEVELOPMENT VEHICLE REQUESTS
RESERVING UNIVERSITY VANS
1. Fill out the packet and submit ONE WEEK PRIOR to your trip. Forms can be dropped
off at 214 Dougherty.
a. The first page must be completed and submitted ASAP by the driver.
i. The driver must be certified by Public Safety
ii. Your advisor must also sign this page as well
b. On the second page, list all of the names of the students who will be riding
in the van, along with their emergency contact information.
i. This list is required by Financial Affairs for University Insurance
records.
c. The third page is a trip waiver that must be signed by all of the students
traveling in a university vehicle.
2. Once your reservation has been submitted and approved by Student Development,
ONLY the assigned driver can take their van confirmation and driver’s license to the
Public Safety Office at Farrell Hall and pick up van keys.
3. If your group, class or office is using a university van for the first time, please make
sure that Amber Grier has the account number that van mileage should be charged
to.
VAN CHARGES
Accounts that are submitted for van reservation(s) will be charged $.32 per mile
Departments and/or offices that did not contribute vans into the van fleet pool
will be charged an additional $25 per van request.
REMEMBER:
Bring your van confirmation and driver’s license when picking up van keys
Keys must be returned to Farrell Hall at the end of your trip
Vehicles must be returned to the designated parking area (back of West Main Parking
Lot)
Van reservations must be cancelled at least 24 hours in advance or you will be charged
a cancellation fee of $10.
One violation will result in loss of van privileges for one month.
Second violation will result in loss of van privileges for the semester.
Questions? Contact Amber Grier at 610-519-4210 or at amber.grier@villanova.edu
Van cancellations after 5pm, call 610-519-6998 or 6992
OFFICE OF STUDENT DEVELOPMENT
VAN REQUEST FORM
Organization ____________________________________________________________
Account Number_________________________________________________________
Date/Dates Requested _____________________________________________________
Destination______________________________________________________________
Purpose of Trip __________________________________________________________
7 or 12 Passenger Van ____________________________________________________
Pick-up/Return time of van_________________________________________________
Name of Certified Driver ___________________________________________________
Driver’s Cell Phone/E-mail_________________________________________________
DRIVER PLEASE READ THE FOLLOWING STATEMENTS; SIGNING
BELOW CONFIRMS AGREEMENT:
 I understand that the van must be returned to the West Main parking lot.
 I understand that the keys for the van must be returned to Farrell Hall
 I understand that I am responsible for returning the van with a minimum quarter
tank full of gas.
 I understand that the interior of the van must be clean upon return.
 I understand that if the van is involved in an accident/incident, I will report it
immediately to Villanova Public Safety and the Office of Student Development.
 I understand that if the van and keys are not returned on time, my group will
lose van privileges.
 I confirm that I have passed the University’s driver certification program,
have submitted a Motor Vehicle Report Consent Form, and registered as a
driver at villanova.agilefleet.com.
_____________________________________________
__________________
Signature of Certified Driver
Date
_____________________________________________
Advisor Name (Printed)
_____________________________________________
__________________
Signature of Advisor
Date
NAME
LOCAL ADDRESS
PERSON TO CONTACT
IN EMERGENCY
CONTACT PHONE
VILLANOVA UNIVERSITY
ASSUMPTION OF RISK AND RELEASE
FIELD TRIPS AND OFF-CAMPUS ACTIVITIES
VILLANOVA UNIVERSITY CLUB FIELD TRIP AND OFF-CAMPUS ACTIVITIES
WAIVER AND ASSUMPTION OF RISK
I, the undersigned, desire to participate in the ___________________________________ Club (the
“Club”), a voluntary activity sponsored by Villanova University, during the Fall/Spring semester of
2013-2014. As part of the Club activities, I understand that I will be traveling to and from various
locations in University vehicles. In return for being permitted to participate in the Club, and
understanding that there are certain risks associated with such Club activities and in traveling to and
from various locations in connection with such Club activities (together “the Activities”), and
intending to be legally bound hereby, I the UNDERSIGNED, for myself, my assigns and legal
representatives hereby agree to:
1.
RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE, Villanova
University, its successors, assigns, affiliates, officers, directors, employees and agents
from all manner of actions and causes of action, suits, debts, judgments, claims and
demands whatsoever in law or equity, including all claims for personal injury or
property damage arising in any way out of my participation in the Activities.
2.
ASSUME ANY AND ALL RISKS arising from my participation in the Activities,
including, without limitation, the risks of death, bodily injury or property damage, the
unavailability of emergency medical care or the negligent or deliberate act of another
person.
3.
INDEMNIFY, DEFEND AND HOLD VILLANOVA UNVERSITY and its officers and
employees and agents harmless from, any and all claims, cause of action, damages,
judgments, costs or expenses, including attorney’s fees, whatsoever, arising from my
participation in the Activities.
4.
I certify that I have no medical condition that would preclude or restrict my participation
in the Activities and that I have adequate health insurance protection to cover the expense
of any unforeseen accident or injury. I recognize that Villanova University does not
carry or maintain health, medical or disability insurance coverage for my participation in
the Activities and is not obligated to attend to any of my medical or medication needs; I
assume all risk and responsibility therefore.
5.
I further acknowledge that Villanova University does not carry property insurance that
applies to theft or loss of my personal property in connection with the Activities. I
understand that University will not be responsible for any physical damage to or theft or
loss of my personal belongings in connection with the Activities.
6.
I acknowledge that I have read and understand this WAIVER and that by signing it I
surrender valuable rights, which I have done freely and voluntarily.
PRINTED NAME:
SIGNATURE:
DATE:
PARENT NAME: (If participant is under 18)
PARENT SIGNATURE and DATE: