Rideshare Participant Application and Agreement

Rideshare Participant Application and Agreement

Thank you for your interest in Skagit Transits Rideshare Program. To get started, please complete the requested information in the fields below.
Contact Information
Name

First NameLast Name
(Check all below that apply)
Primary Phone Number

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Is your primary phone number a mobile phone?
Is your alternate phone number a mobile phone?
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Contact
Employer Information
Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone Number

Area CodePhone Number
Group Information
Are you joining a new or existing group?
Group Number
Van Number
Vanpool Manager Name:
Acknowledgements:

My signature below certifies that:
- I have received the Skagit Transit Vanpool Participant Agreement.
- I have read, understand, and agree to abide by all terms of the Agreement.
- I understand my rights and responsibilities as a Vanpool Participant.
- I agree to properly wear my seatbelt at all times. (Failure to do so may result in immediate revocation of riding privileges by Skagit Transit.)
Signature
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Contact Information