Ride Buddy – I-Ride

Name *

Phone *

Address *

Apt, suite, etc.

Country

City

State

Zip code

Date of Birth *

Any disabilities we should be aware of or special service we should provide? *

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Please choose one of the following *

I would like to be picked up and dropped off at home

I will drive to 2100 Transportation Dr., and that is where I would like to be dropped off

Do you have any problems climbing stairs? *

Do you have any problems riding with service animals? *

Do you get motion sickness? *

Do you have a problem helping passengers with packages? *

Do you have a problem staying on the bus with children while the driver assists another passenger? *

Do you have a problem with persons with disabilities? *

For what length of time do you intend to participate in this program? *

Why are you interested in volunteering for this program? *

Do you have any questions/ concerns? *