RideLink Registration

When you submit your registration, please allow five (5) business days before contacting us at 844.694.6589 to verify registration.

To complete this form, you must be a Kent County resident 60 years of age or older.

Personal Information

First Name*

Last Name*

Middle Initial

Street Address*

Apt.

City*

County*

Zip*

Primary Phone*

Alternate Phone

Date of birth*

Gender*

Select...

Do you consider yourself to be transgender or gender non-conforming? *

Select...

Sexual Orientation

Select...

Household Size (How many people are living in the household?)*

Estimated Annual Income*

Race/Ethnicity (For Multi-racial, check all that apply) *

Are you a US Veteran?*

Select...

Would you describe yourself as having a disability?

Select...

Do you use a wheelchair when you travel?

Select...

Do you need assistance getting to and from the vehicle?

Select...

Will you be using any mobility device when you travel? (walker, cane, walker with oxygen, service animal, etc.)

Do you require a mechanical lift to board the bus?

Select...

First Name*

Last Name*

Primary Phone*

Alternate Phone

Relationship to Client*