Youth Registration

River Cities Public Transit

"*" indicates required fields

Step 1 of 2

**Youth morning rides are at max capacity, all registrations for the morning will be put on a wait list. RCPT will reach out to those parents when availability becomes open again.**

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 Information

Passengers Name*

First Last

Date of Birth*

For Federal reporting requirements.

Gender*

Male

Female

For Federal reporting requirements

Ethnicity*

For Federal reporting requirements.

What is the passengers primary address?*

Street Address City

Does the passenger have a secondary address?

Yes

What is the passengers secondary address?*

Street Address City

Which school is this passenger going to?*

Physical 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 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

Medicaid Number*

Passenger Walk on or use a Mobility Device?*

Walk on

Mobility Device

Is it okay to drop off the passenger unattended?*

Yes

**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

NOTE: This does not apply to children 4 and under.

Is the passenger part of the YMCA Kidstop Program?*

Yes

Is the passenger part of the Boys & Girls aftershool Program?*

Yes

Has the passenger had a farecard in the past?*

Yes

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 Comments

Passenger #1 Schedule

NOTE: 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*

End Date*

Are all pickup and drop off locations the same?*

Yes

Days Needing A Ride*

Monday

Tuesday

Wednesday

Thursday

Friday

Pick up Time*

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

Pick up Time*

Monday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Monday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Tuesday

Pick Up Location*

Click if it is the same as physical address for passenger #1 above.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Tuesday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Wednesday

Pick Up Location*

Click if this address is the same as the primary address above.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Wednesday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Thursday

Pick Up Location*

Click if it is the same as physical address for passenger #1 above.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Thursday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Friday

Pick Up Location*

Click if it is the same as physical address for passenger #1 above.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Friday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

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

Passenger #2 Name*

First Last

Date of Birth*

For Federal reporting requirements.

Passenger #2 Gender*

Male

Female

For Federal reporting requirements

Ethnicity*

For Federal reporting requirements.

Does Passenger #2 have the same physical address as passenger #1?

Yes

Primary Address For Passenger # 2

Street Address City

Does passenger #2 have a secondary address?

Yes

What is passenger #2's secondary address?*

Street Address City

Which school is passenger #2 going to?*

Physical 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

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

**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

NOTE: This does not apply to children 4 and under.

Is the passenger #2 part of the YMCA Kidstop Program?*

Yes

Is passenger #2 part of the Boys & Girls afterschool Program?*

Yes

Has passenger #2 had a farecard in the past?*

Yes

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 Comments

Passenger #2 Schedule

NOTE: 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*

End Date

Are all pickup and drop off locations the same?*

Yes

Days Needing A Ride*

Monday

Tuesday

Wednesday

Thursday

Friday

Pick up time

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

Pick Up Time*

Monday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up time

Drop Off Location*

Street Address City

Does passenger #2 need a return trip on Monday?

Yes

Pick Up Location*

Street Address City

Pick up time*

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Tuesday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up time

Drop Off Location*

Street Address City

Does passenger #2 need a return trip on Tuesday?

Yes

Pick Up Location*

Street Address City

Pick up time

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Wednesday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up time

Drop Off Location*

Street Address City

Does passenger #2 need a return trip on Wednesday?

Yes

Pick Up Location*

Street Address City

Pick up time

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Thursday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up time

Drop Off Location*

Street Address City

Does passenger #2 need a return trip on Thursday?

Yes

Pick Up Location*

Street Address City

Pick up time

Drop Off Location*

Check if this address is the same as the primary address above.

Street Address City

Friday

Pick Up Location*

Check if this address is the same as the primary address above.

Street Address City

Pick up time

Drop Off Location*

Street Address City

Does passenger #2 need a return trip on Friday?

Yes

Pick Up Location

Street Address City

Pick up time

Drop Off Location*

Street Address City

Yes

Passenger #3 Name*

First Last

Date of Birth*

For Federal reporting requirements.

Passenger #3 Gender*

Male

Female

For Federal reporting requirements

Ethnicity*

For Federal reporting requirements.

Does passenger #3 have the same physical address as the passenger #1?

Yes

Physical Address for passenger #3*

Street Address City

Does passenger #3 have a secondary address?

Yes

What is passenger #3's secondary address?*

Street Address City

Which school is passenger #3 going to?*

Physical 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

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

**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

NOTE: This does not apply to children 4 and under.

Is passenger #3 part of the Boys & Girls aftershool Program?*

Yes

Is passenger #3 part of the YMCA Kidstop Program?*

Yes

Has passenger #3 had a farecard in the past?*

Yes

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 Comments

Passenger #3 Schedule

NOTE: 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*

End Date*

Are all pickup and drop off locations the same?

Yes

Days Days Needing A Ride*

Monday

Tuesday

Wednesday

Thursday

Friday

Pick up Time*

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

Pickup Time*

Monday

Pick Up Location*

Check box if this address is the same as the primary address for this passenger.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Monday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check box if this address is the same as the primary address for this passenger.

Street Address City

Tuesday

Pick Up Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Tuesday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Wednesday

Pick Up Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Wednesday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Thursday

Pick Up Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Thursday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Friday

Pick Up Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Pick up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Friday?*

Yes

Pick Up Location*

Street Address City

Pick up Time*

Drop Off Location*

Check this box if the address is the same as the primary address for this passenger.

Street Address City

Yes

Passenger #4 Name*

First Last

Date of Birth*

Passenger #4 Gender*

Male

Female

For Federal reporting requirements

Ethnicity*

For Federal reporting requirements.

Does passenger #4 have the same physical address as passenger #1?

Yes

Physical address for passenger #4*

Street Address City

Does passenger #4 have a secondary address?

Yes

What is passenger #4's secondary address?*

Street Address City

Which school is passenger #4 going to?*

Physical 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

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

**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

Is passenger #4 part of the YMCA Kidstop program?*

Yes

Is passenger #4 part of the Boys & Girls afterschool program?*

Yes

Has passenger #4 had a farecard in the past?*

Yes

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 Comments

Passenger #4 Schedule

NOTE: 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*

End Date*

Are all pick up and drop off locations for passenger #4 the same?*

Yes

Days Needing a Ride*

Monday

Tuesday

Wednesday

Thursday

Friday

Pick Up Time*

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

Pick up time

Monday

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Does Passenger #4 Need A Return Trip on Monday?*

Yes

Pick Up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Tuesday

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Does Passenger #4 Need A Return Trip on Tuesday?*

Yes

PIck Up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Wednesday

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Does Passenger #4 Need A Return Trip on Wednesday?*

Yes

Pick Up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Thursday

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Does Passenger #4 Need A Return Trip On Thursday?*

Yes

Pick Up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Friday

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do passenger #4 need a return trip on Friday?*

Yes

Pick Up Location*

Street Address City

Pick Up Time*

Pick Up Location*

Click if it is the same as physical address for passenger #4 above?

Street Address City

Yes

Passenger #5 Name*

First Last

Date of Birth*

Passenger #5 Gender*

Male

Female

For Federal reporting requirements

Ethnicity*

For Federal reporting requirements.

Does passenger #5 have the same physical address as passenger 1?

Yes

Physical address for passenger #5*

Street Address City

Does passenger #5 have a secondary address?

Yes

What is passenger #5's secondary address?*

Street Address City

Which school is passenger #5 going to?*

Physical 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

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

**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

Is passenger #5 part of the YMCA Kidstop program?*

Yes

Is passenger #5 part of the Boys & Girls afterschool program?*

Yes

Has passenger #5 had a farecard in the past?*

Yes

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 Schedule

NOTE: 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*

End Date*

Are all pick up and drop off locations the same?*

Yes

Days Needing a Ride*

Monday

Tuesday

Wednesday

Thursday

Friday

Pick Up Time*

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

Pick up time*

Monday

Pick up Location*

Click if it is the same as physical for passenger #5 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Monday?*

Yes

Pick up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Tuesday

Pick up Location*

Click if it is the same as physical address for passenger #5 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Tuesday?*

Yes

Pick up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Wednesday

Pick up Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Wednesday?*

Yes

Pick up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Thursday

Pick up Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Thursday?*

Yes

Pick up Location*

Street Address City

Pick Up Time*

Drop Off Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Friday

Pick up Location*

Click if it is the same as physical address or passenger #5 above?

Street Address City

Pick Up Time*

Drop Off Location*

Street Address City

Do they need a return trip on Friday?*

Yes

Is the parent or legal guardian the emergency contact?*

Yes

May we text you in the event we cannot reach you by phone?

Yes

Carrier rates may apply depending on your cell phone plan

May we text you in the event we cannot reach you by phone?

Yes

Carrier rates may apply depending on your cell phone plan

May we text you in the event we cannot reach you by phone?

Yes

Carrier rates may apply depending on your cell phone plan

Pick up Location*

Street Address City

Pick Up Time*

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 Information

Parent or Legal Guardians Name*

First Last

Physical Address*

Street Address City State

Parent or Legal Guardians Phone Number*

Parent or Legal Guardians Email*

Emergency Contact Information

Who 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*

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