Maternity of the Blessed Virgin Mary Catholic Church

Youth Ministry Driver Information

As a Driver for Camp MOSH, please complete the following form:

Vehicle that will be used:

Insurance Information:

Please note: The minimal, acceptable liability limit for privately-owned vehicles is $100,0i00/$300,000)

Please be aware when using a personal vehicle, your insurance is primary. There is a policy that would offer additional liability protection should a claim exceed the limits of your policy.

Driving History:

Have you had any of the following citations or convictions in the past THREE years?


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