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Paratransit/Citizen's Accessible Transit System (CATS)

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CATS Application
Citizen's Accessible Transit System

Optional: To download the application, fill it out and send it in, please click here to download.

Please fill out this form completely. Uncompleted forms will be discarded.
Fields marked with * are required.

If you have mobility difficulties that limit you from using the fixed route accessible buses, you may be eligible to participate in the CATS program. Please complete all the information below so that the Coast may assist you with your transportation needs.

Applicant Information

* Last Name:

* First Name:

Middle Initial:

* Email Address:

Physical / Street Address:

Apartment / Unit #:

City:

State:

Zip Code:

Mailing Address:

Apartment / Unit #:

City:

State:

Zip Code:

* Home Phone Number:

Work Phone Number:

Alternate Phone Number:

Date of Birth:

Sex:

Emergency Contact

First Contact Name:

First Contact Relationship:

First Contact Phone:

Second Contact Name:

Second Contact Relationship:

Second Contact Phone:

Transportation Information

After reading the attached eligibility criteria, please answer the following questions:

What is your current means of transportation?:

What prevents you from using lift-equipped fixed route buses?:

Is your inability to use fixed route service a temporary or permanent situation?:

If temporary, how long?:

Other Specified Above:

Describe the impairment which causes your mobility to be limited:

If you have concerns about our vehicles (Goshen Van 10" in height) ability to safely access your residence for passenger pick up, please explain (ex: Low trees, awnings, steep hills, archways, etc.):

Will you have any other persons traveling with you? (For further information, please see the CATS policies and procedures guide.):

Additional Comments:

Acknowledgement

I agree that I will pay the exact fare, if required, for each trip. I agree to notify Coast's CATS office of any changes in my staus which may affect my eligibility to use the service. I also understand that failure to adhere to the policies and procedures will be grounds for revoking my application and the right to participate in the program. I understand and agree to hold Coast RTA Waccamaw Regional Transportation Authority harmless against all claims or liability for damages to any person, property, or personal injury occuring as a result of my failure to equip or maintain the safety measures of the adaptive equipment or certified guide/service animal that I require for mobility. I have read and fully understand the conditions for service outlined above and agree to abide by them.

Certification of Eligibility Release

I hereby authorize the release of the certification information and any additional information to Coast RTA Waccamaw Regional Transportation Authority for the purposes of evaluating my eligibility to participate in The CATS program. I further understand that any such information will be kept confidential.

This certified that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

If you click submit, you are giving Coast RTA your electronic signature, which is binding in a court of law.

* This is a printer friendly version of the original page, made to save you ink and paper.

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Bus Route Status

CATS ApplicationCitizen's Accessible Transit System

CATS ApplicationCitizen's Accessible Transit System

CATS Application
Citizen's Accessible Transit System

CATS Application
Citizen's Accessible Transit System