Driver Authorization - August Camp

Appalachian Mountain Club - August Camp
Authorization Form to Drive Camp Vehicles

Disclosure of Intent to Obtain a Motor Vehicle Record (Please Read)

In compliance with the Fair Credit Reporting Act and the Driver Privacy Act, we hereby notify you that we may request a Motor Vehicle Record in connection with your application to drive August Camp vehicles. It is our normal practice to limit the report to driving records available from the appropriate state departments of motor vehicles. This report is procured for risk management purposes.

Certification of Receipt of Disclosure of Intent and Authorization to Obtain a Motor Vehicle Record *

I acknowledge that I have received a copy of the “Disclosure of Intent to Obtain a Motor Vehicle Record.” I voluntarily authorize you to obtain a Motor Vehicle Record regarding me in connection with my application to drive August Camp vehicles for risk management purposes. I understand and agree that I can revoke this authorization only in writing and the revocation will be effective only upon receipt.

Which week(s) are you attending camp? *

Week 1
Week 2
Week 3
Week 4

First Name *

Last Name *

Maiden or other names under which records may be listed.

Cell Phone

Email *

Date of Birth *

* Date of birth information will be used by the reporting agency to ensure an accurate investigation.

Driver's License Number *

State Issued *

Please review all your information before submitting.

Phone

Appalachian Mountain Club - August Camp
Authorization Form to Drive Camp Vehicles

Disclosure of Intent to Obtain a Motor Vehicle Record (Please Read)

Please review all your information before submitting.

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Appalachian Mountain Club - August CampAuthorization Form to Drive Camp Vehicles

Disclosure of Intent to Obtain a Motor Vehicle Record (Please Read)

Please review all your information before submitting.

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Appalachian Mountain Club - August Camp
Authorization Form to Drive Camp Vehicles