Ride Request Form

We believe in the power of community support. If you need a ride to a recovery-related activity, please fill out the request form below. For the best chance of securing a ride, we kindly ask that you submit your request at least 24 hours in advance. We're here to help you get where you need to go on your journey to recovery. 

We kindly ask that you consider the following:

• Submit requests 1–2 days in advance when possible.
• Ride priority goes to those new in recovery and/or new to the area (1-30 Days). 
• When able, obtain phone numbers and build a recovery network.

 Our goal is to be supportive while encouraging sustainability.

Note: If all information is not filled out fully it may affect possibility of getting ride.

Date of Request:

Date

Date When Ride Is Needed:

Date

From Address:

Text field

To Address:

Text field

Where Are You Going?:

Text field

Meeting/Appointment Start Time:

Text field

First and Last Name:

Client first nameClient last name

CLEAN/RECOVERY/SOBER Date:

Date

Best Contact Number:

Text field

Reason For Ride:

i.e First Meeting, First Shift At Work, etc. 

Paragraph

How Will This Help You On Your Journey Of Recovery?:
Paragraph