AnchorRIDES Enrollment Form Senior Citizen - Municipality of - muni 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Last Name, First Name, and the last four digits of your Social Security Number. Ensure accuracy as this information is crucial for eligibility.
3. Fill in your contact details including Home Phone, Cell, Work, and Email Address. This will help facilitate communication regarding your enrollment.
4. Provide your Street Address and Mailing Address. If you have a second mailing address for correspondence, include that as well.
5. List Emergency Contacts with their names, relationships, and phone numbers to ensure safety during transportation.
6. Indicate any Special Communications Needs and Accessibility requirements you may have to tailor the service to your needs.
7. Complete the Health Information section by checking any applicable conditions that may affect your transportation needs.
8. Review the Consent for Services section carefully before signing. This confirms your agreement to share necessary information with relevant agencies.
9. Finally, return the completed application via mail, fax, or email as provided at the end of the form.

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