Rider Profile Form Rider Name * Date of Birth * Gender * Male Female Home Address * Primary Contact Name * Primary Contact Number * Primary Contact Relationship * Alternate Contact Name * Please give us contact information for the destination, either here or in the emergency contact information. Alternate Contact Number * Alternate Contact Relationship * Email Address Special ADA Needs * Yes No If Yes * Wheelchair Walker Cane N/A Other Special Accommodations For minor's age 10 and under, Rainbow Rider's policy is that a responsible adult must be present to accept the minor. If drop off is at a school, a teacher or aide should be present. WAVER:Minor can be dropped off without an adult present * Yes No Emergency Contact Information Name * Relationship * Contact Phone * Alternate Phone * Name Relationship Contact Phone Alternate Phone Terms Accept I have reviewed and understand all information included with this document. If your having issues with this form, CLICK HERE for a downloadable version.