Online Rider Registration Form - River Cities Public Transit

Today's Date:*

Date to begin riding:*

Passengers Name:*

First Middle Last

Address:*

Street Address City State ZIP Code

Birth Date:*

Age:*

Male or Female?:*

Male
Female

Cell Phone:

Home Phone:*

Walk-On or Use of Mobility Device?:*

Walk-On
Mobility Device

Ethnicity:*

Medicaid?*

Yes
No

Medicaid #:

Additional Comments?:

Legal Guardian (if applicable)

This will be the person we contact with any issues

Name:

First Last

Address:

Street Address City State ZIP Code

Phone:

Email Address:

In Case of Emergency

Name of Local Friend or Relative:

Relationship to Passenger:

Phone:

Passenger and/or Legal Guardian

Please read and check each box below:

No Show and Cancellation Agreement*

I Agree

In an effort to provide excellent customer service to all of our clients, and to provide the best possible transportation services, it is our policy to require a fee for a no showed ride. Please keep in mind you can cancel up to 1 hour before the scheduled ride with our office (605) 945-2360 or on the Shah My-Ride App without being assessed a no show fee. It is your responsibility to call us and cancel in advance. The fee to be deducted will be the amount of the no showed ride and will be deducted from your fare card. In the event you do not have a fare card a no show fee will be added to your next ride or be added to your profile. Before riding again the no show fee will need to be paid in full or no transportation will be given.

The above information is true to the best of my knowledge.:*

Yes, I confirm.

Parent/Guardian Signature:*

Date:*

Rider Registration Form

Reload your Fare card!

Order A Ride

Veteran Transportation

Fill out and submit your Rider Registration Form

Legal Guardian (if applicable)

In Case of Emergency

Passenger and/or Legal Guardian

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