Transportation

Application to Ride

Please complete the application online using the form below, or download a printable version to complete and mail it to us.

To apply by mail:

  1. Download the PDF application.
  2. Print and complete the form.
  3. Mail it to 650 Letica Drive, Rochester, MI 48307
Download Form

Rider Information

Gender(Required)
Address(Required)

Mobility Requirements

To help us better serve your transportation needs, please state any medical concerns and/or limitations:
Do you require a lift?(Required)
Do you require an aide?(Required)

Emergency Contact Information

Please Complete and Sign

Transportation Rider Policy(Required)

Rules for riders to follow:

  • OPC is NOT meant to be your only means of transportation
  • Rides are based on a first come, first serve basis with priority given to:
    1. Work Rides
    2. Medical appointments
    3. Grocery Shopping
    4. Senior Rides
    5. All Others
  • OPC does not allow transportation for medical emergencies. Call 911.
  • All pick-up and drop-off points must be handicap accessible. Drivers are not allowed to bring wheelchairs or similar devices down stairs or over door sills.

Release of Claims:

In the event of an emergency, I authorize OPC to secure medical treatment deemed reasonable and necessary for my immediate care. I agree that I am responsible for payment of any medical services rendered to me.

Clear Signature

Or download a printable version to complete and mail it to us.

Download Form
Transportation
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