THE CATHOLIC UNIVERSITY OF AMERICA CLUB SPORTS AUTHORIZATION FOR TRAVEL

							                       THE CATHOLIC UNIVERSITY OF AMERICA- CLUB SPORTS
                              AUTHORIZATION FOR TRAVEL ROSTER

This must be filled out and faxed or hand delivered to the Director of Club Sports (x6199) and to the Department of
Public Safety (x5110) 48 hours, PRIOR to anyone leaving the campus for the trip. All traveling members must be on
this form. Send any updates/corrections/additions prior to departure.

CLUB:
EVENT:
PERSON FILLING OUT THIS FORM:

Date of Departure:                  Estimated Time:
Place of Departure:                 Mode of Transportation:
Destination/s:                      (see reverse)
Staying at (motel):                 Phone:
Date of Return:                     Estimated Return Time:

                                         Contact person at destination

      Name & Title: ____________________________________                  Phone number:_________________

                                        TRAVEL ROSTER (be accurate)

Last Name             First Name           Contact number (cell phone- minimum one per vehicle)

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                                           (Must also fill out second page)
Page 2. Authorization for Travel Roster

Drivers’ Information

Private Vehicles:
You must have permission from the owner of the private vehicle to use it for Club Sports.
Your own automobile insurance will cover property damage and/or personal injury arising from an automobile
accident arising from use of the vehicle. The Catholic University of America assumes no responsibility for the
use of private vehicles. The automobile owner assumes liability. All drivers must possess a valid driver's
license, and complete the affirmation below.

University Vehicles:
You must have undergone the University’s large vehicle training program and receive certification to drive
University vans and/or other large vehicles. You must provide proof of a current driver’s license and affirm that
you have never been convicted of DUI or DWI and that you have fewer than 3 points on your driving record.

All drivers must affirm:
I have provided proof of a current driver’s license. I affirm that I have never been convicted of DUI or DWI and
that I have fewer than 3 points on my driving record.

Drivers:
                                     Private or             Affirm?                Cellphone
Last Name      First Name            University Vehicle?     (yes/no            (min 1 per vehicle)


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