Backup Ride Home Enrollment Form
All personal information will be treated confidentially and will only be used by the Center for Community Transportation staff to confirm enrollment in and use of the program.
First Name *
Your answer
Last Name *
Your answer
E-mail address *
Your answer
Cell phone number *
Your answer
Home Address *
Your answer
Employer *
Your answer
Regular work hours *
(e.g. 9am-5pm, 8pm-2am, or "evenings, variable")
Your answer
I...(check all that apply)
If you are a TCAT bus rider, please provide your TCard number, fob number, or ID card number.
By answering this question, you acknowledge that we may check your bus pass status with TCAT.
Your answer
Commute Modes
Backup Ride Home is only available on days when your commute plan included use of the bus, carpool or vanpool, bicycle or walking.
Please indicate how frequently you use each commute mode.
Often (More than once a week)
Occasional (More than once a month)
Rarely (Less than once a month)
Never
Bus
Carpool or vanpool
Bike
Walking
Taxi or ridehail
Drive alone
Backup Ride Home Waiver and Release of Liability
I request to participate in the Center for Community Transportation’s Backup Ride Home (BRH) Program. I have read and agree to abide by the policies, rules and regulations of the Backup Ride Home Program (www.ithacacarshare.org/backup-ride-home). I understand that transportation to my home or other destination allowed by the BRH Program may be provided to me by third party taxi, ridehailing or other transportation service, and that the Center for Community Transportation may identify choices among participating providers. I understand that the Center for Community Transportation is not responsible for the performance of any transportation provider under this program.

I hereby assume full legal and medical responsibility and all risk of injury or loss, including death or serious bodily harm, and/or loss of property and income, which may result from my participation in this program. I forever release the Center For Community Transportation and its funders, solely in such capacity as a program funder and not in any other capacity, and their respective directors, officers, Board members, employees, agents, and volunteers (collectively, “Releasees”) from any and all claims, actions, suits, demands, damages, liabilities, losses, costs and expenses I may now have, or may have in the future, by reason of any accident, illness, injury or death, or damage to or loss or destruction of any property, arising or resulting directly or indirectly from my participation in the BRH Program, whether or not such accident, illness, injury, death or loss is caused, or alleged to be caused, in whole or in part, by the negligent acts or omissions of any Releasee. I also agree not to sue, bring any claim against, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. The terms of this release shall serve as a release and assumption of risks for all my heirs, executors, administrators, and for all of my family members.

I acknowledge that inappropriate or fraudulent use of this service will require that I reimburse the Center for Community Transportation for all expenses incurred.

I give permission to the Center for Community Transportation to check whether I have an Ithaca Carshare membership or meet another eligibility factor based on my employment or other status. If my eligibility is based on my status as a TCAT passholder, I give permission to the Center for Community Transportation to verify with TCAT, both now and from time to time, the type of pass that I hold and its duration and validity.

I give permission to the Center for Community Transportation to share my name, telephone number, and pick-up and drop-off addresses with eligible transportation providers of my choice for the sole purpose of transmitting my BRH ride request details to them, and for those eligible providers to use and store that information.

I affirm that the information I have provided is true. I understand and acknowledge that my enrollment can be discontinued by myself or the Center for Community Transportation at any time. I further understand and acknowledge the BRH Program may be changed or discontinued at any time without notice.
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