Youth Registration River Cities Public Transit "*" 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* 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* End Date*
