Volunteer Driver Informed Consent
Organization is a non-profit transportation service
that provides community-based, consumer-oriented transportation for adults age
60 or older, for people with special needs or disabilities, and for others in
the community. Organization is a part of the ITNAmerica
national network. The research and
development of the ITN network has been made possible through support from The
Atlantic Philanthropies, The Great Bay Foundation for Social Entrepreneurs, AARP,
the Transportation Research Board, the Federal Transit Administration, the
National Highway Traffic Safety Administration, and numerous other
philanthropic organizations.
Each of these organizations has
an interest in the development of non-profit transportation that helps older
adults and other community members meet their mobility needs with dignity and
independence. Your participation as a volunteer driver or volunteer is an important part of the development of this service.
The questions on this application
help us understand the reasons why you and others choose to volunteer for Organization, and the history of your volunteer effort helps us develop a record of community participation so we
may better understand how to support and expand community-based transportation
across the country. Your identity is strictly confidential.
Your signature indicates: 1) You
understand that you will be participating in a project that uses the data
collected from your volunteer driving efforts or other volunteer efforts for research to develop the transportation service
and to better understand transportation for older adults and other individuals
with special needs; and 2) You agree to maintain the confidentiality of
Organization's customers and their families.
Volunteer Driver Change of Status
It is the responsibility of the volunteer driver to notify organization of any changes in relevant driver information.
Please notify an Organization representative of any incidents of changes related
to the list below, and submit copies of new documents before their expiration
dates.
·
Change of insurance policy, agent, or carrier
·
Accidents
·
Moving violations
·
New/different vehicles
·
Criminal convictions
·
Significant medical issues that affect driving
·
Change in license status
I understand that I need to report any changes in the above
to organization, and agree to do so in a timely manner.
By typing your name in the box below and submitting this form, you agree that your digital signature will be considered your legal signature and represents your agreement to the terms and policies outlined above.