Youth Registration "*" indicates required fields Step 1 of 2 50% PLEASE READ BEFORE YOU BEGIN: Through this form, you can register up to 5 passengers. NOTE: If you have more than 5 passengers to register, please call our dispatch center at 605-945-2360. Thank you. Passenger InformationPassengers Name* First Last Date of Birth* MM slash DD slash YYYY For Federal reporting requirements.Gender* Male Female For Federal reporting requirementsEthnicity*African AmericanCaucasianHispanicNative AmericanOtherFor Federal reporting requirements.What is the passengers primary address?* Street Address City Does the passenger have a secondary address? Yes No What is the passengers secondary address?* Street Address City Which school is this passenger going to?*T.F. Riggs H.S.Georgia Morse M.S.Jefferson ElementaryKennedy ElementaryBuchanan ElementarySt JosephsFor His GloryOahe Child Development CenterStanley CountyHighmore-HarroldHaakon CountyHome SchoolBeyond The ClassroomOtherPhysical Address of TF Riggs* Street Address City Physical Address of Georgia Morse Middle School Street Address City Physical Address of Jefferson Elementary School Street Address City SDAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Physical Address of Kennedy Elementary School Street Address City Physical Address of Buchannan Elementary School Street Address City Physical Address of St. Joseph's School Street Address City Physical Address of For His Glory School Street Address City Physical Address of for Oahe Child Development Center Street Address City Physical Address of for Stanley County Street Address City Physical Address of for Highmore - Harrold Street Address City Physical Address of for Haakon County Street Address City Physical Address of for Home School Street Address City Physical Address of for Beyond The Classroom Street Address City Physical Address Other Street Address City Does Passenger have a Medicaid Number?* Yes No Medicaid Number* Passenger Walk on or use a Mobility Device?* Walk on Mobility Device Is it okay to drop off the passenger unattended?* Yes No **NOTE: This means no parent or guardian needs to be home to accept the child.Is it okay for the passenger to make changes to the schedule?* Yes No NOTE: This does not apply to children 4 and under.Is the passenger part of the YMCA Kidstop Program?* Yes No Is the passenger part of the Boys & Girls aftershool Program?* Yes No Has the passenger 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) Additional CommentsPassenger #1 ScheduleNOTE: This will set a standing reservation for the entire year. If you require a change to the standing reservation, please call our dispatch at 605-945-2360.Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Are all pickup and drop off locations the same?* Yes No Days Needing A Ride* Monday Tuesday Wednesday Thursday Friday Pick up Time* Hours : Minutes AM PM AM/PM Pick Up Location* Click if it is the same as the primary address for passenger #1. Street Address City Drop Off Location* Street Address City Does this passenger need a return trip? Yes No Pick up Time* Hours : Minutes AM PM AM/PM MondayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Monday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City TuesdayPick Up Location* Click if it is the same as physical address for passenger #1 above. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Tuesday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City WednesdayPick Up Location* Click if this address is the same as the primary address above. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Wednesday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City ThursdayPick Up Location* Click if it is the same as physical address for passenger #1 above. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Thursday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City FridayPick Up Location* Click if it is the same as physical address for passenger #1 above. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Friday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City Would you like to register a second passenger?* Yes No Passenger #2 Name* First Last Date of Birth* MM slash DD slash YYYY For Federal reporting requirements.Passenger #2 Gender* Male Female For Federal reporting requirementsEthnicity*African AmericanCaucasianHispanicNative AmericanOtherFor Federal reporting requirements.Does Passenger #2 have the same physical address as passenger #1? Yes No Primary Address For Passenger # 2 Street Address City Does passenger #2 have a secondary address? Yes No What is passenger #2's secondary address?* Street Address City Which school is passenger #2 going to?*T.F. Riggs H.S.Georgia Morse M.S.Jefferson ElementaryKennedy ElementaryBuchanan ElementarySt JosephsFor His GloryOahe Child Development CenterStanley CountyHighmore-HarroldHaakon CountyHome SchoolBeyond The ClassroomPhysical Address of TF Riggs* Street Address City Physical Address of Georgia Morse Middle School Street Address City Physical Address of Jefferson Elementary School Street Address City Physical Address of Kennedy Elementary School Street Address City Physical Address of Buchannan Elementary School Street Address City Physical Address of St. Joseph's School Street Address City Physical Address of For His Glory School Street Address City Physical Address of for Oahe Child Development Center Street Address City Physical Address of for Stanley County Street Address City Physical Address of for Highmore - Harrold Street Address City Physical Address of for Haakon County Street Address City Physical Address of for Home School Street Address City Physical Address of for Beyond The Classroom Street Address City Does Passenger #2 have a Medicaid Number?* Yes No Medicaid Number* Passenger #2 Walk on or use a Mobility Device?* Walk On Mobility device Is it okay to drop off passenger #2 unattended?* Yes No **NOTE: This means no parent or guardian needs to be home to accept the child.Is it okay for passenger #2 to make changes to the schedule?* Yes No NOTE: This does not apply to children 4 and under.Is the passenger #2 part of the YMCA Kidstop Program?* Yes No Is passenger #2 part of the Boys & Girls afterschool Program?* Yes No Has passenger #2 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) Additional CommentsPassenger #2 ScheduleNOTE: This will set a standing reservation for the entire year. If you require a change to the standing reservation, please call our dispatch at 605-945-2360.Start Date* MM slash DD slash YYYY End Date MM slash DD slash YYYY Are all pickup and drop off locations the same?* Yes No Days Needing A Ride* Monday Tuesday Wednesday Thursday Friday Pick up time Hours : Minutes AM PM AM/PM Pick Up Location* Check if address is the same as the primary address for passenger #2 above. Street Address City Drop Off Location* Street Address City Does passenger #2 need a return trip?* Yes No Pick Up Time* Hours : Minutes AM PM AM/PM MondayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does passenger #2 need a return trip on Monday? Yes No Pick Up Location* Street Address City Pick up time* Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City TuesdayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does passenger #2 need a return trip on Tuesday? Yes No Pick Up Location* Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City WednesdayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does passenger #2 need a return trip on Wednesday? Yes No Pick Up Location* Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City ThursdayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does passenger #2 need a return trip on Thursday? Yes No Pick Up Location* Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Check if this address is the same as the primary address above. Street Address City FridayPick Up Location* Check if this address is the same as the primary address above. Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does passenger #2 need a return trip on Friday? Yes No Pick Up Location Street Address City Pick up time Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Register a third passenger?* Yes No Passenger #3 Name* First Last Date of Birth* MM slash DD slash YYYY For Federal reporting requirements.Passenger #3 Gender* Male Female For Federal reporting requirementsEthnicity*African AmericanCaucasianHispanicNative AmericanOtherFor Federal reporting requirements.Does passenger #3 have the same physical address as the passenger #1? Yes No Physical Address for passenger #3* Street Address City Does passenger #3 have a secondary address? Yes No What is passenger #3's secondary address?* Street Address City Which school is passenger #3 going to?*T.F. Riggs H.S.Georgia Morse M.S.Jefferson ElementaryKennedy ElementaryBuchanan ElementarySt JosephsFor His GloryOahe Child Development CenterStanley CountyHighmore-HarroldHaakon CountyHome SchoolBeyond The ClassroomPhysical Address of TF Riggs* Street Address City Physical Address of Georgia Morse Middle School Street Address City Physical Address of Jefferson Elementary School Street Address City Physical Address of Kennedy Elementary School Street Address City Physical Address of Buchannan Elementary School Street Address City Physical Address of St. Joseph's School Street Address City Physical Address of For His Glory School Street Address City Physical Address of for Oahe Child Development Center Street Address City Physical Address of for Stanley County Street Address City ZIP Code Physical Address of for Highmore - Harrold Street Address City Physical Address of for Haakon County Street Address City Physical Address of for Home School Street Address City Physical Address of for Beyond The Classroom Street Address City Does passenger 3 have a Medicaid Number?* Yes No Medicaid Number* Does passenger 3 walk on or use a mobility device?* Walk on Mobility device Is it okay to drop off passenger #3 unattended?* Yes No **NOTE: This means no parent or guardian needs to be home to accept the child.Is it okay for the passenger #3 to make changes to the schedule?* Yes No NOTE: This does not apply to children 4 and under.Is passenger #3 part of the Boys & Girls aftershool Program?* Yes No Is passenger #3 part of the YMCA Kidstop Program?* Yes No Has passenger #3 had a farecard in the past?* Yes No Do they still have in in their possession?* Yes (please bring it into the office to have it re-stamped) No (replacement charge of $5 will be applied) Additional CommentsPassenger #3 ScheduleNOTE: This will set a standing reservation for the entire year. If you require a change to the standing reservation, please call our dispatch at 605-945-2360.Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Are all pickup and drop off locations the same? Yes No Days Days Needing A Ride* Monday Tuesday Wednesday Thursday Friday Pick up Time* Hours : Minutes AM PM AM/PM Pick Up Location* Check box if this address is the same as the primary address for this passenger. Street Address City Drop Off Location* Street Address City Does passenger #3 need a return trip?* Yes No Pickup Time* Hours : Minutes AM PM AM/PM MondayPick Up Location* Check box if this address is the same as the primary address for this passenger. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Monday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check box if this address is the same as the primary address for this passenger. Street Address City TuesdayPick Up Location* Check this box if the address is the same as the primary address for this passenger. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Tuesday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check this box if the address is the same as the primary address for this passenger. Street Address City WednesdayPick Up Location* Check this box if the address is the same as the primary address for this passenger. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Wednesday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check this box if the address is the same as the primary address for this passenger. Street Address City ThursdayPick Up Location* Check this box if the address is the same as the primary address for this passenger. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Thursday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check this box if the address is the same as the primary address for this passenger. Street Address City FridayPick Up Location* Check this box if the address is the same as the primary address for this passenger. Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Friday?* Yes No Pick Up Location* Street Address City Pick up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Check this box if the address is the same as the primary address for this passenger. Street Address City Register a 4th passenger?* Yes No Passenger #4 Name* First Last Date of Birth* MM slash DD slash YYYY Passenger #4 Gender* Male Female For Federal reporting requirementsEthnicity*African AmericanCaucasianHispanicNative AmericanOtherFor Federal reporting requirements.Does passenger #4 have the same physical address as passenger #1? Yes No Physical address for passenger #4* Street Address City Does passenger #4 have a secondary address? Yes No What is passenger #4's secondary address?* Street Address City Which school is passenger #4 going to?*T.F. Riggs H.S.Georgia Morse M.S.Jefferson ElementaryKennedy ElementaryBuchanan ElementarySt JosephsFor His GloryOahe Child Development CenterStanley CountyHighmore-HarroldHaakon CountyHome SchoolBeyond The ClassroomPhysical Address of TF Riggs* Street Address City Physical Address of Georgia Morse Middle School Street Address City Physical Address of Jefferson Elementary School Street Address City Physical Address of Kennedy Elementary School Street Address City Physical Address of Buchannan Elementary School Street Address City Physical Address of St. Joseph's School Street Address City Physical Address of For His Glory School Street Address City Physical Address of for Oahe Child Development Center Street Address City Physical Address of for Stanley County Street Address City Physical Address of for Highmore - Harrold Street Address City Physical Address of for Haakon County Street Address City Physical Address of for Home School Street Address City Physical Address of for Beyond The Classroom Street Address City Does passenger #4 have a Medicaid number?* Yes No Medicaid Number* Does passenger #4 walk on or use a mobility device?* Walk on Mobility device Is it okay to drop off passenger #4 unattended?* Yes No **NOTE: This means no parent or guardian needs to be home to accept the child.Is it okay for passenger #4 to make changes to the schedule?* Yes No Is passenger #4 part of the YMCA Kidstop program?* Yes No Is passenger #4 part of the Boys & Girls afterschool program?* Yes No Has passenger #4 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) Additional CommentsPassenger #4 ScheduleNOTE: This will set a standing reservation for the entire year. If you require a change to the standing reservation, please call our dispatch at 605-945-2360.Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Are all pick up and drop off locations for passenger #4 the same?* Yes No Days Needing a Ride* Monday Tuesday Wednesday Thursday Friday Pick Up Time* Hours : Minutes AM PM AM/PM Pick up Location* Click if it is the same As Passenger #4 Address Above? Street Address City Drop off Location* Street Address City Does passenger #4 need a return trip? Yes No Pick up time Hours : Minutes AM PM AM/PM MondayPick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does Passenger #4 Need A Return Trip on Monday?* Yes No Pick Up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address for passenger #4 above? Street Address City TuesdayPick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does Passenger #4 Need A Return Trip on Tuesday?* Yes No PIck Up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address for passenger #4 above? Street Address City WednesdayPick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does Passenger #4 Need A Return Trip on Wednesday?* Yes No Pick Up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address for passenger #4 above? Street Address City ThursdayPick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Does Passenger #4 Need A Return Trip On Thursday?* Yes No Pick Up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address for passenger #4 above? Street Address City FridayPick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do passenger #4 need a return trip on Friday?* Yes No Pick Up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Pick Up Location* Click if it is the same as physical address for passenger #4 above? Street Address City Register a 5th passenger?* Yes No Passenger #5 Name* First Last Date of Birth* MM slash DD slash YYYY Passenger #5 Gender* Male Female For Federal reporting requirementsEthnicity*African AmericanCaucasianHispanicNative AmericanOtherFor Federal reporting requirements.Does passenger #5 have the same physical address as passenger 1? Yes No Physical address for passenger #5* Street Address City Does passenger #5 have a secondary address? Yes No What is passenger #5's secondary address?* Street Address City Which school is passenger #5 going to?*T.F. Riggs H.S.Georgia Morse M.S.Jefferson ElementaryKennedy ElementaryBuchanan ElementarySt JosephsFor His GloryOahe Child Development CenterStanley CountyHighmore-HarroldHaakon CountyHome SchoolBeyond The ClassroomPhysical Address of TF Riggs* Street Address City Physical Address of Georgia Morse Middle School Street Address City Physical Address of Jefferson Elementary School Street Address City Physical Address of Kennedy Elementary School Street Address City Physical Address of Buchannan Elementary School Street Address City Physical Address of St. Joseph's School Street Address City Physical Address of For His Glory School Street Address City Physical Address of for Oahe Child Development Center Street Address City Physical Address of for Stanley County Street Address City Physical Address of for Highmore - Harrold Street Address City Physical Address of for Haakon County Street Address City Physical Address of for Home School Street Address City Physical Address of for Beyond The Classroom Street Address City Does passenger #5 have a Medicaid number?* Yes No Medicaid Number* Does passenger #5 walk on or use a mobility device?* Walk on Mobility device Is it okay to drop off passenger #5 unattended?* Yes No **NOTE: This means no parent or guardian needs to be home to accept the child.Is it okay for passenger #5 to make changes to the schedule?* Yes No Is passenger #5 part of the YMCA Kidstop program?* Yes No Is passenger #5 part of the Boys & Girls afterschool program?* Yes No Has passenger #5 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) Passenger #5 ScheduleNOTE: This will set a standing reservation for the entire year. If you require a change to the standing reservation, please call our dispatch at 605-945-2360.Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Are all pick up and drop off locations the same?* Yes No Days Needing a Ride* Monday Tuesday Wednesday Thursday Friday Pick Up Time* Hours : Minutes AM PM AM/PM Pick up Location* Click if it is the same as physical address for passenger #5 above? Street Address City Drop off Location* Street Address City Does passenger #5 need a return trip?* Yes No Pick up time* Hours : Minutes AM PM AM/PM MondayPick up Location* Click if it is the same as physical for passenger #5 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Monday?* Yes No Pick up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address or passenger #5 above? Street Address City TuesdayPick up Location* Click if it is the same as physical address for passenger #5 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Tuesday?* Yes No Pick up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address or passenger #5 above? Street Address City WednesdayPick up Location* Click if it is the same as physical address or passenger #5 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Wednesday?* Yes No Pick up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address or passenger #5 above? Street Address City ThursdayPick up Location* Click if it is the same as physical address or passenger #5 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Thursday?* Yes No Pick up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address or passenger #5 above? Street Address City FridayPick up Location* Click if it is the same as physical address or passenger #5 above? Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Street Address City Do they need a return trip on Friday?* Yes No Is the parent or legal guardian the emergency contact?* Yes No May we text you in the event we cannot reach you by phone? Yes No Carrier rates may apply depending on your cell phone planMay we text you in the event we cannot reach you by phone? Yes No Carrier rates may apply depending on your cell phone planMay we text you in the event we cannot reach you by phone? Yes No Carrier rates may apply depending on your cell phone planPick up Location* Street Address City Pick Up Time* Hours : Minutes AM PM AM/PM Drop Off Location* Click if it is the same as physical address or passenger #5 above? Street Address City 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 1 business day after youth registration form is completed. Youth will need their farecard or cash for all rides (this includes BGC and YMCA).* I Understand Parent or Legal Guardians InformationParent or Legal Guardians Name* First Last Physical Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Parent or Legal Guardians Phone Number*Parent or Legal Guardians Email* Emergency Contact InformationWho do we contact if we cannot get hold of a parent or legal guardian. Name* First Last Phone*Relationship* Policies and Information BULLYING 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. 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. 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. I understand that lack of payment will cause interruption in service. I understand that payment is to be made either in advance or upon boarding the bus. 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 2 business days to process. I understand that I need to pre-schedule (by 9pm the night before) to receive discount rates. I understand RCPT's no show policy (I may incur additional fees and 3 no shows in a row will cancel my standing reservation). I understand that if my child no show's RCPT will deduct the no show fee from my child's fare card. I understand that any cancelations must be made a minimum of 1 hour prior to requested pick up times. I understand that altering a prescheduled ride must be made by 9pm the day before or I risk paying the same day fare. I understand that I am responsible for updating my personal information as needed (i.e. change of address or phone number). I understand that RCPT reserves the right to refuse service. I understand that RCPT is committed to providing NON-discriminatory service and that I may call the office with concerns. 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. If child damages bus, Parent/Guardians is responsible for damages. As the parent or legal guardian, I agree with the policies and information I have just read. I agree. No Show & Cancellation Policy: 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. If child damages the bus, the Parent/Guardians is responsible for damages. As the parent or legal guardian, I agree with the No Show and Cancellation Policy* I agree Signature* Δ
