Request edit access
Register as a rider
registering because I am ready to book a trip
registering in anticipation of using the service in the future
Rider's First and Last Name
Do you require wheelchair accessible transportation?
I use a wheelchair, and require accessible transportation
I use a folding wheelchair but can transfer to a passenger vehicle
I do not require accessible transportation
Year of Birth
For statistical purposes, and to determine eligibility for certain automatically applied fare subsidies
If different than your street address, please list under "other" - We use this information to mail out important policies and changes to our service!
My mailing address is the same as my street address
If you check regularly and would prefer us to contact you this way!
Emergency Contact Name
Someone we can contact in case of an emergency during a trip
Emergency Contact Phone Number
Your emergency contact's relationship to you
Select all that apply
I use a cane
I use a walker
I cannot get into/out of a vehicle without assistance
I have visual impairment
I have hearing impairment
I travel with an oxygen tank
OPTIONAL: Why are you interested in using this service?
Check all that apply
I do not own a vehicle due to economic barriers
I own a vehicle, but have economic barriers that keep me from operating it
I cannot operate a vehicle due to health/mobility barriers
I own a vehicle, but sometimes it is not available when being used by other family members.
Consent for Collections, Use and Discloser of Information
In order to accomplish our service, we collect personal information from our riders. This information is not shared by Queens County Transit, except for statistical purposes (where personally identifiable information is not included), and is used by our organization to tailor our services to your needs.
Do you consent to the collection, use and discloser of your information?
I am registering for someone else, but they give their consent
I am an QCT dispatcher registering a new rider by phone
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service