Emergency Ride Home Application

Countywide Emergency Ride Home Application

Application Agreement and Baseline Survey
  • To qualify for the Countywide ERH Program you must travel to work at least one day a week by: bus, carpool, vanpool, bicycle, electric bicycle, or walking, and you must agree to complete one follow-up survey within a year. This baseline survey is to help the Ecology Action establish commuter habits of Santa Cruz County residents. All information will remain anonymous. I plan to use the following travel methods to get to work in the upcoming year (put estimated number of days per week):
  • What obstacles prevent you from using an alternative mode of transportation more often to commute to work?
  • Please read the following carefully: Participant Agreement: I understand the guidelines of the Emergency Ride Home Program and qualify by traveling to work at least one day per week using an alternative mode of transportation. I understand that the vouchers are non-transferable, and that the vouchers are to be used during work hours, and only on days when I have used an alternative mode of transportation for my commute. I agree to complete one follow up survey within a year of the date the voucher is issued to me, whether or not I use the voucher. Program is subject to end due to limited funds. By clicking the "Send Now" button, I agree to comply with the conditions of this program and hereby release Ecology Action from any liability, claims, and demands for personal injury, loss, theft, or damage to my personal property; loss of income, consequential damage resulting from delays or absence of a taxi cab, or termination of the program.
  • This field is for validation purposes and should be left unchanged.