Dial A Ride Application

PASADENA DIAL-A-RIDE APPLICATION

Thank you for your interest in applying for Pasadena Dial-A-Ride. Please read the Dial-A-Ride Membership Information and Requirements prior to submitting your application. If you aren’t able to scan or provide a copy of your supporting documents, please call our main office for assistance (626) 744-4094.

Pasadena Dial A Ride Program Banner Image

Submit the following to process your Dial-A-Ride membership:

City of Pasadena Dial-A-Ride Application (you will complete below)
Scan/photo of identification with your date of birth, such as Drivers License (front and back)
Scan/photo of Proof of Residency (if not provided on your identification) such as utility bill, etc. (front and back)
Scan/photo of Reduced Fare TAP card, if applicable (LACTOA/Disabled or Access required for applicants under 60 years) (front and back)

One or more fields below is invalid

Application Type

First Name

Last Name

Email Address

DOB (##/##/####)

Gender

Home Address

** Click on blue 'Add' button to add address

Home Phone #

Mobile Phone #

Type of Residence

Name of Living Facility (if applicable)

Facility Phone # (if applicable)

Do you have a Reduced Fare TAP Card?

If Yes, indicate which type of TAP Card?

TAP Card #

I use the following (select all that apply)

I speak (select all that apply)

Do you require a self-provided escort?

STATISTICAL INFORMATION - FOR FUNDING PURPOSES

This information is voluntary. Please check one box only that you most closely identify with:

EMERGENCY CONTACT INFORMATION:

Contact

Relationship

Phone

UPLOAD ATTACHMENTS:

(acceptable file formats - .gif, .jpg, .png and .pdf)

Scan/photo of identification with your date of birth, such as Drivers License (front and back)
Proof of Residency (if not provided on your identification) such as utility bill, etc. (front and back)
Scan/photo of Reduced fare TAP card, if applicable (front and back)

NOTE: If you have trouble uploading documents, call (626) 744-4094 the Dial-A-Ride Administrative Office for assistance

Click here or drag files into this box to upload file(s)

I assume full responsibility for, release, and agree not to sue the City of Pasadena, its City Council, officers, employees, and representatives, the City of San Marino, and Los Angeles County from any liability for my safety and well-being before I board and after I exit the Pasadena DIAL-A-RIDE vehicle.

** You must confirm to submit a Dial A Ride application **

Add Address

PASADENA DIAL-A-RIDE APPLICATION

Submit the following to process your Dial-A-Ride membership:

City of Pasadena Dial-A-Ride Application (you will complete below)

Scan/photo of identification with your date of birth, such as Drivers License (front and back)

Scan/photo of Proof of Residency (if not provided on your identification) such as utility bill, etc. (front and back)

Scan/photo of Reduced Fare TAP card, if applicable (LACTOA/Disabled or Access required for applicants under 60 years) (front and back)

STATISTICAL INFORMATION - FOR FUNDING PURPOSES

EMERGENCY CONTACT INFORMATION:

UPLOAD ATTACHMENTS:

Scan/photo of identification with your date of birth, such as Drivers License (front and back)

Proof of Residency (if not provided on your identification) such as utility bill, etc. (front and back)

Scan/photo of Reduced fare TAP card, if applicable (front and back)