Youth Transportation River Cities Public Transit Reload your Fare card! Order A Ride Order Veteran Transportation FollowFollow Note: This page will not load consistently using Internet ExplorerWe recommend using Chrome or Firefox to view this website Youth Registration Form Step 1 of 3 33% Passenger InformationPassengers Name* First Middle Last Physical Address* Street Address City State ZIP / Postal Code Is Mailing address same as Physical Address?* Yes No Mailing Address* Street Address City State / Province / Region ZIP / Postal Code Date of Birth* Date Format: MM slash DD slash YYYY Ethnicity*Gender* Male Female Does Passenger have a Medicaid Number?* Yes No Medicaid Number*Passenger Walk On or Use a Mobility Device?* Walk On Mobility Device Additional CommentsIs it okay to drop off child unattended (No parent or guardian needs to be home to accept the child)?* Yes No Is it okay for child to make changes to schedule (does not pertain to children 4 and under)?* Yes No N/A Is the child part of the Kidstop Program?* Yes No Has the child had a farecard in the past?* Yes No Do they still have it in their possession?* Yes (please bring it into the office to have it re-stamped) No (Replacement charge of $5 will be applied) If your child needs a farecard it will need to be to picked up at the RCPT office before their first scheduled ride. Card can be picked up 24hrs after youth registration form is completed. Youth will need their farecard or cash for all rides (this includes BGC and YMCA).* I Understand Legal Guardians InformationLegal Guardians Name* First Last Physical Address* Street Address City State ZIP / Postal Code Is Mailing Address same as Physical Address?* Yes No Mailing Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Email* Emergency Contact InformationName* First Last Phone*Relationship*Policies and InformationBULLYING WILL NOT BE TOLERATED " I understand any misconduct on the bus will result in a verbal warning to the youth transit rider and if the problem persists a parent and/or guardian will be notified. Misconduct may result in suspension depending on severity and/or whether or not a problem has persisted after verbal warnings. The length of suspension will depend on the seriousness of the misconduct."* Yes No " I understand because of the high volume of rides during peak times that drivers may not be able to wait the full five minutes and routes will be set up to accommodate everyone."* Yes No I hereby acknowledge that River Cities Public Transit has a no refund policy on ALL fares. Lost fare cards will cost an extra fee to make another one although the original balance will still be attached to the name of the client.* Yes No I understand that lack of payment will cause interruption in service.* Yes No I understand that payment is to be made either in advance or upon boarding the bus.* Yes No RCPT asks that all reloads over the phone will need to be made 1 hour prior to the scheduled ride. Paypal reloads could take up to 24 hrs to process.* Yes No I understand that I need to pre-schedule (by 9pm the night before) to receive discount rates.* Yes No I understand RCPT's no show policy (I may incur additional fees and 3 no shows in a row will cancel my standing reservation).* Yes No I understand that if my child no show's RCPT will deduct the no show fee from my child's fare card.* Yes No I understand that any cancelations must be made a minimum of 1 hour prior to requested pick up times.* Yes No I understand that altering a prescheduled ride must be made by 9pm the day before or I risk paying the same day fare.* Yes No I understand that I am responsible for updating my personal information as needed (i.e. change of address or phone number).* Yes No I understand that RCPT reserves the right to refuse service.* Yes No I understand that RCPT is committed to providing NON-discriminatory service and that I may call the office with concerns.* Yes No I understand that as a parent/guardian if I'm not outside when RCPT drops off child, child will be taken to RCPT office unless otherwise given permission to drop off unattended. Local authorities will be notified if we cannot get in contact with the legal guardian or emergency contact.* Yes No If child damages bus, Parent/Guardians is responsible for damages.* Yes No I understand due to the spread of Covid-19 we encourage our passengers to wear a mask and wash or sanitize frequently, however, it is not mandated at this time. RCPT will continue to thoroughly clean our buses and follow CDC guidelines to help control the spread. We do ask that if your child is feeling ill that you cancel their bus ride or let our dispatcher know so we can better help get you and your child to where you need to be safely.* Yes No No Show and Cancellation Policy* 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. Passenger ScheduleStart Date* Date Format: MM slash DD slash YYYY End Date* Date Format: MM slash DD slash YYYY Days Needing a Ride* Sunday Monday Tuesday Wednesday Thursday Friday Saturday Are all pick up times and locations the same?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City SundayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City MondayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City TuesdayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City WednesdayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City ThursdayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City FridayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City SaturdayPick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Do they need a return trip?* Yes No Pick up Location* Street Address City Pick Up Time* : HH MM AM PM Drop Off Location* Street Address City Signature*
