Rides for GOOD

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Passenger Registration

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Online Passenger Registration Form

In order to establish eligibility, please complete the form listed below to register to be a passenger of Rides for Good.
All information collected is considered private and will not be shared with any one or organization.
Mandatory information is marked with an asterisk (*).

Printable PDF Version of Form (Optional)

(if using PDF version of form):
Please email completed form to [email protected]

Please enable JavaScript in your browser to complete this form.

YOUR INFORMATION

Address
Race (check all that apply)

_____________________________

EMERGENCY CONTACT

Address

_____________________________

DETAILS ABOUT YOUR RIDE

Note - each passenger must have a Passenger Waiver Form signed and on file in our office before a ride can be scheduled.
(Ex. Limited vision, walker use, need assistance walking, etc.)

_____________________________

FOR WHAT PURPOSE(S) DO YOU ENVISION USING RIDES FOR GOOD?
Check all that apply.
If none, please write none or N/A

_____________________________

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