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Pre-registration is required. Each participant must complete a personal data sheet registration form to use this service. This form will enroll you in the program and provide critical information. After completing the necessary one time registration form you are now ready to ride.

Complete the form below and select Submit. If submission is successful a notification will appear.

If you prefer a to complete a hard copy of the form please see the "Schedule A Ride" page.

AODT Rider Data Sheet

* Indicates required field

Name *

First

Last

Gender *

Male Female

Date of Birth *

MM/DAY/YEAR

I identify my ethnicity as: (this field is optional) *

White/Caucasian Black/African American Asian Hispanic Other

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Alternate Phone Number *

Select All That Apply *

Disabled Elderly Developmental Disability Temporary Mobility Issue Low Income

Special Travel Requirements *

Wheelchair Walker Ramp Oxygen Other

If OTHER, please specify *

Driver Instructions *

Door to Door Supervision Until Inside Supervision Until Visually Notified No Supervision Required

Will an aid be traveling with rider? *

Yes No

Communication Needs *

Special Instructions or any known food allergies AODT should be aware of: *

Directions to Residence *

Emergency Contact 1 *

First

Last

Emergency Contact Phone Number *

Emergency Contact 2 *

First

Last

Emergency Contact 2 Phone Number *

Submit

ATHENS ON DEMAND TRANSIT
3 Cardaras Drive
Glouster, OH 45732
PHONE: (740) 597-2404
FAX: (740) 767-2301