Follow us

Help us grow our family

STEP 1 OF 3

Client Information and Release Form

NEXT

STEP 2 OF 3

Do you have any limitations? Please circle what applies:

NEXT

STEP 3 OF 3

EMERGENCY CONTACT INFORMATION:

Payment Method ($40 Annual Membership):

If you have any questions, please call Margaret Smith Hale, Executive Director, at 860.758-7833 or email ctseniorrides@gmail.com

By clicking “Continue”, you agree to our Terms and Conditions and Privacy Policy.