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Youthful Operator Driver Safety Agreement?

My Driver Safety Agreement

Driving is a privilege that I may lose by violating this agreement or may have suspended for other reasons such as (but not limited to) unsatisfactory school grades and violations of family trust.

  • I will obey any curfews or restrictions imposed by my driver's license.
  • I will obey all traffic laws and speed limits.
  • I will not drink and drive, or use illegal drugs, or drive if I am taking ANY medication that may affect my driving.
  • I will not ride with anyone whom I know or suspect is under the influence of alcohol or drugs (legal, or illegal).
  • I will not permit any open or empty containers of alcohol, or transport anyone who I know or suspect may be carrying illegal drugs in any vehicle I operate.
  • I will not ride in any vehicle where I know that there are empty or open containers of alcohol or where anyone who I know or suspect may be carrying illegal drugs.
  • I agree not to drive with or transport anyone who is in possession of a firearm or other "weapon."
  • I will always wear my seatbelt and shoulder harness. I will not ride in any vehicle in which there are more people than seat belts.
  • I will make certain that I can always hear emergency vehicles and traffic sounds.
  • I will drive defensively, recognizing the driving dangers posed by other drivers.
  • I willI will not transport passengers unless they are properly secured by a seatbelt.
  • I will always wear a helmet if I am driving or riding on a motorcycle. I will not transport a passenger unless he or she also wears a helmet.
  • I will drive in a manner that respects the safety of myself, my passengers, other drivers and pedestrians.
  • I will ignore peer pressure. While driving, I am in control. I can stop and ask others to leave my vehicle and, as a passenger, I can ask a driver to stop and let me out.
  • I will not drive unless I feel safe and certain of my ability.
  • I will be especially alert during dangerous conditions such as rain, snow, sleet, wind, heavy traffic, construction zones, and accident scenes.
  • I will always lock every door and take the keys when I leave the vehicle. I will park in areas where I believe the vehicle will be safe from damage or theft.
  • I will obey the driving instructions of my parent(s) and of law enforcement officers.
  • Additional Conditions Required By My Parent(s)
  • ________________________________________________________________
  • ________________________________________________________________

I have read, understood and I will comply with this agreement.

Signed______________________ Witnessed_________________________

Date:_______________________

Revised: 08/01


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Auto, Home, Farm, Business, Life and Home Insurance
Leitch Insurance Agency, Inc :: 174 E Pine St :: P O Box 85 :: River Falls, WI 54022 :: Phone 715-425-0159 :: Fax 715-425-6439
LEITCH INSURANCE AGENCY IS LICENSED IN THE STATES OF WISCONSIN, MINNESOTA, ARIZONA, AND SEVERAL OTHER STATES.