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

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.

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.