YOUR GUIDE TO TEEN DRIVING BY ALLIED INSURANCE
DRIVING COMMITMENT FORM
LET’S MAKE A DRIVING DEAL
We encourage parents and teens to complete this driving agreement together.
TEEN DRIVING AGREEMENT
Drivers Licensed
0-6 Months
Drivers Licensed
6-12 Months
Drivers Licensed
12-18 Months
Drivers Licensed
18-24 Months
Daytime
driving:
Never
Never
Never
Never
Nighttime
driving:
Never
Never
Never
Never
Driving Stages
Cell phone usage
Violate agreement. Lose driving privileges for _______ weeks _______ months
Number of
Teen passengers
Daytime
driving:
Nighttime
driving:
Violate agreement. Lose driving privileges for _______ weeks _______ months
Weather conditions
Nighttime
driving:
q other ______
Daytime
driving:
Nighttime
driving:
Violate agreement. Lose driving privileges for _______ weeks _______ months
Nighttime driving
q other ______
Daytime
driving:
Violate agreement. Lose driving privileges for _______ weeks _______ months
Road types
q other ______
q other ______
Curfew
time:
Violate agreement. Lose driving privileges for _______ weeks _______ months
q other ______
Drove intoxicated
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Rode with an
intoxicated driver
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Did not wear
seatbelt
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Drove aggressive
or reckless
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Got a speeding
ticket
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Involved in an
at-fault accident
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Wasn’t honest about
where he or she
went with the car
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
Came home late and
didn’t call to explain
Violated agreement. Lose driving privileges for _______ weeks _______ months
other _______
I promise to abide by the contract outlined above. If I break any part of this contract, I will accept the consequences.
TEEN SIGNATURE: ___________________________________________________ DATE:_________________________
PARENT SIGNATURE: _________________________________________________ DATE:_________________________
YOUR GUIDE TO TEEN DRIVING BY ALLIED INSURANCE
DRIVING COMMITMENT FORM
LET’S MAKE A DRIVING DEAL
Parents should commit to safe driving practices, too, and set an example for their teen. Parents and teens
should complete this driving agreement together.
PARENT DRIVING AGREEMENT
I will always observe and provide coaching in a calm, respectful manner.
____ Parent Initials ____ Teen initials
I will provide practice on a variety of road types and driving conditions
____ Parent Initials ____ Teen initial
I will always wear a seatbelt
____ Parent Initials ____ Teen initial
I will always obey all traffic laws
____ Parent Initials ____ Teen initial
I will not drive aggressively
____ Parent Initials ____ Teen initial
I will not use a cellphone while driving
____ Parent Initials ____ Teen initial
I will not drink and drive
____ Parent Initials ____ Teen initial
I promise to do what I can to help my teen succeed in following this contract. I promise to make time to
help my teen become a safe and responsible driver. I understand this is an evolving contract and promise
to make myself available to discuss these rules and consequences when necessary.
PARENT SIGNATURE: _________________________________________________ DATE:_________________________
TEEN SIGNATURE: ____________________________________________________ DATE:_________________________
Nationwide, the framemark and On Your Side are service marks of Nationwide Mutual Insurance Company. © 2011 Nationwide Mutual Insurance Company. All rights reserved.
APR-0124AO (01/12)