Carpool Agreement

1.	The purpose of this carpool is to transport children to [name of activity] ______________________________, located at ______________________________.
2.	The carpool agreement will begin on [date] _____________ and end on [date] ____________.
3.	The carpool route will be: ______________________________.
4.	Inbound trip: the carpool will pick up the first child at [time] _____________ and deliver all children at the destination at [time] ____________________.
5.	Outbound trip: the carpool will meet the children at [time] _____________ and deliver the last child by [time] __________________.
6.	Special agreements (waiting time, alternate drop-off sites, etc.): ___________________________________________________.
7.	The members of the carpool and the riders are: ___________________________________________________.

Child # 1:
Child’s name: ______________________________
Inbound pick-up address: ______________________________
Outbound drop-off address: ______________________________
Parent(s)’ or guardian(s)’ name(s): ______________________________
Parents’/Guardians’ address: ______________________________
Parents’/Guardians’ contact information: 
home: ____________ work: ____________ cell: _________ email: ___________
Parents’/Guardians’ work address: ______________________________
Driver’s name: ______________________  Drivers’ License Number: _______________
Driver’s address, if different from above: ______________________________
Driver’s phone, if different from above: ______________________________
Model, make, and license number of vehicle(s) driver expects to use: __________________________________
Name of insurance company: ___________________________________
Names, phone numbers, and relationship to you/child of two people to call, other than those listed above, in an emergency: ______________________________________________
Name and phone number of child’s physician: __________________________________

Child # 2:
Child’s name: ______________________________
Inbound pick-up address: ______________________________
Outbound drop-off address: ______________________________
Parent(s)’ or guardian(s)’ name(s): ______________________________
Parents’/Guardians’ address: ______________________________
Parents’/Guardians’ contact information: 
home: ____________ work: ____________ cell: _________ email: ___________
Parents’/Guardians’ work address: ______________________________
Driver’s name: ______________________  Drivers’ License Number: _______________
Driver’s address, if different from above: ______________________________
Driver’s phone, if different from above: ______________________________
Model, make, and license number of vehicle(s) driver expects to use: __________________________________
Name of insurance company: ___________________________________
Names, phone numbers, and relationship to you/child of two people to call, other than those listed above, in an emergency: ______________________________________________
Name and phone number of child’s physician: __________________________________

Child # 3:
Child’s name: ______________________________
Inbound pick-up address: ______________________________
Outbound drop-off address: ______________________________
Parent(s)’ or guardian(s)’ name(s): ______________________________
Parents’/Guardians’ address: ______________________________
Parents’/Guardians’ contact information: 
home: ____________ work: ____________ cell: _________ email: ___________
Parents’/Guardians’ work address: ______________________________
Driver’s name: ______________________  Drivers’ License Number: _______________
Driver’s address, if different from above: ______________________________
Driver’s phone, if different from above: ______________________________
Model, make, and license number of vehicle(s) driver expects to use: __________________________________
Name of insurance company: ___________________________________
Names, phone numbers, and relationship to you/child of two people to call, other than those listed above, in an emergency: ______________________________________________
Name and phone number of child’s physician: __________________________________

8.	By signing this Agreement, I agree to abide by its terms to the best of my ability. I understand that any member of the carpool can cease participation without notice, but agree to give as much notice as is possible under the circumstances. I understand that if a member is not fulfilling his or her responsibilities, that member may be asked to leave. I understand that this document is not a legally binding agreement and is entered into in a spirit of cooperation and a shared desire to make the carpool work well for the benefit of the children and their parents.

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Parent or Guardian Signature	Date

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Parent or Guardian Signature	Date

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Parent or Guardian Signature	Date

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Parent or Guardian Signature	Date