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R-Transit Online Application

  1. Gender*

  2. Section I: Valid Identification & Proof of Residency

  3. idadd.JPG

  4. Upload an acceptable form of identification

  5. Upload proof of residency

  6. Section II: Emergency Contact Information

    Please provide a name and telephone number of a contact person in the event of an emergency.

  7. Section III

    Please answer the following questions - your specific answers to the questions will familiarize us with your individual needs.

  8. 3. How do you currently travel to your destinations? Check all that apply. *

  9. 4. Do you use any of the following mobility aids or specialized equipment? Check all that apply.

  10. Does your residence have a ramp to accomodate your wheelchair or scooter?*

  11. Does the wheelchair or scooter have a seatbelt?*

  12. Can your manual wheelchair be folded?*

  13. 5. Can you transfer into a vehicle with minimal assistance?*

  14. 6. Does a personal care attendant accompany you when you travel outside the home?*

  15. Section IV

    Age and Disability verification

  16. Proof of disability

    Applicants between the ages of 18-54 must provide proof of disability. Select the proof of disability you will provide:

  17. Upload a scan of your Medicare card in jpg format

  18. Upload a scan of your receipt in pdf or jpg format

  19. Upload a scan of your RTC card in jpg format

  20. Upload a scan of your certification with East Bay Paratransit in pdf format

  21. Upload your signed form in pdf format

  22. Upload the completed and stamped form in pdf format

  23. Section V: RAPID: On Demand Service with Lyft

  24. The City of Richmond has contracted with Lyft to provide on demand transportation service for registered R-Transit clients. The R-Transit program’s newest addition, RAPID, will offer R-Transit clients a subsidy to use Lyft. Lyft is a ridesharing application that connects people with a nearby driver and transports them to their destination. Lyft is not a replacement for an ambulance, and should not be used as a means of emergency transport.

  25. Lyft is best suited for those comfortable with boarding vehicles (including SUVs and vans) without driver assistance. Due to the nature of Lyft, drivers are not required to assist passengers in and out of the vehicle, assist with personal belongings, or walk passengers to their destination. Lyft’s policy is that passengers who use wheelchairs that can safely and securely fit in the car’s trunk or backseat without obstruction the driver’s view will be accommodated by the Lyft driver. R-Transit clients who are able to fold and store their wheelchair on board without the assistance of drivers and able to transfer in and out of the vehicle independently or with the assistance of an accompanying assistance can use Lyft.

  26. To use the RAPID, R-Transit clients will need a smart phone, and a credit/debit card. RAPID will allow R-Transit clients to receive a subsidy to use Lyft for a maximum of forty (40) one way trips per month. R-Transit clients will pay $3.00 for each one-way trip within the service area and the City of Richmond will cover the remaining fare up to $17.00 per one-way trip. If the total cost of the trip exceeds $20.00, the client will be responsible for the overage. R-Transit’s service area includes: Richmond, El Cerrito, North Richmond, Kensington, El Sobrante, San Pablo, and Pinole. RAPID will also expand service to and from the Regional Contra Costa Medical Center and Veterans Hospital in Martinez, CA.

  27. 1. Do you plan on using Lyft?*

  28. Upload the registration form here. The registration form is the first page of the Waiver of Liability form.

  29. Upload the waiver of liability form here (page 2 of the Waiver of Liability form)

  30. 2. Do you currently use or have you used a ride sharing service (Lyft, Uber, Go Go Grandparent, etc.)?*

  31. 3. Have you installed the Lyft app on your smart phone?*

  32. If no, do you need assistance with installing the Lyft app on your smart phone?*

  33. Section VI

  34. Applicant Certification*

    By checking the box and typing my name below, I am electronically signing my application. I understand all information will be kept confidential and only the information require to provide the services will be disclosed to those who perform the service.

  35. Leave This Blank:

  36. This field is not part of the form submission.