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If you qualify and would like to apply for the Emergency Ride Home service, complete and submit the following application form online. You may also print out and complete the application and fax it to 615-862-6208 or mail it to the RTA office. If you are unsure whether you qualify, please refer to the Policies & Procedures.


Emergency Ride Home Application Form

Name (first & last): 
Home Address 1: 
Home Address 2: 
City: 
State:   ZIP Code: 
Your email address (if you have one):

Nearest major cross street:

Home Phone: (  ) 
Work Phone: (  ) 

Resident County: 
Round trip miles to work: 

Please check if you work:
Flexible hours    Saturdays    Sundays

What is your normal work schedule?
from  AM  PM    to  AM  PM

If you work another shift, tell us the hours:
from  AM  PM    to  AM  PM

Do you need riders?    Yes    No

Please refer to the Emergency Ride Home Policies & Procedures to find out if you are eligible for a cab or a rental car.

Employer Name: 
Employer Address 1: 
Employer Address 2: 

Supervisor’s Name: 
Phone: (  ) 

Work Phone: (  ) 
Work County: 

Name(s) of people with whom you regularly rideshare:
 
Driver's Name: 
 
Work Phone: (  ) 
 
Back-up Driver's Name: 
 
Work Phone: (  ) 
 
Rider 1 Name: 
 
Work Phone: (  ) 
 
Rider 2 Name: 
 
Work Phone: (  ) 
 
Rider 3 Name: 
 
Work Phone: (  ) 
 
Other Riders:

 
Is your rideshare a:    Vanpool    Carpool
 
 Express Bus Route (enter route number)

Additional comments/questions:

I hearby attest that I share a ride to my worksite at least three (3) days a week or fifteen (15) days each month with the person or persons named above. I further attest that I have read the policies and procedures of the Emergency Ride Home service and agree to comply with those policies and procedures. I hearby release the Regional Transportation Authority, its officers, board of directors, agents and employees from all liability, claims, suits, demands or damages for personal injury, loss, theft or damage to my personal property; loss of income; or consequential damages resulting from delays or absence of cab or rental car; or termination of the program.
 
 By checking this box, you confirm the above statement.

    

Quick Links:
Regional Transportation Authority | 130 Nestor Street | Nashville TN 37210 | 615-862-8833 | Fax: 615-862-6208 | Email: rta@nashville.gov
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Clean Air Partner of Williamson County Clean Air Partner of Middle Tennessee Nashville Area Metropolitan Planning Organization Federal Transit Administration Tennessee Department of Transportation