General Public Dial-A-Ride Application

Canby Area Transit General Public Dial A Ride Application

If you live within the Urban Growth Boundary of Canby and would like to register for the General Public Dial-A-Ride service please complete the application below. 

Once your application is completed it will be submitted for review to the Transit Operations Manager. You will then be contacted once your application has been processed. 

Applicant Information:
Date of Birth
Applicant's Date of Birth
Applicant's Contact Information:
Please provide your full ten (10) digit phone number.
Is this a Cell Phone? *
Would you prefer text messaging for your trip reminders? *
CAT sends out a message the night before with your ride times. By default, the message is sent out over the phone. If you prefer, we can also send it via text message to your cell phone. Would you like to receive ride updates via text message?
Please provide a full ten (10) digit phone number.
Is your Secondary Phone a Cell Phone?
Applicant Home Address:
Please complete with your full home address: Number, Street, City, State and Zip Code.
Applicant Mailing Address (if different than home address):
Mailing Address if different than Home Address
Please complete if mailing address is different than your home address above. Include Number, Street, City, State and Zip Code.
Do you use any mobility devices? *
Mobility Device Type Cane / Crutches – Walking or balance assistance Walker / Rollator – Walking support, with or without wheels Manual Wheelchair – Self-propelled or pushed by another person Power Wheelchair – Motorized wheelchair Mobility Scooter – 3- or 4-wheel powered mobility device Other – Any other mobility device used for assistance
Are You interested in Paratransit Dial-A-Ride? *
If you have a medical condition or disability you may qualify for our Paratransit Dial-A-Ride service. Please let us know here if you would like to complete the application for Paratransit Dial-A-Ride service, you can read more about it under our Dial-A-Ride section on the Canby Area Transit website. You can also contact the Transit Operations Manager at 503-266-0717 to see if you would qualify.
Emergency Contact Information:
Emergency contact information if needed for emergency or urgent matters.
Full First and Last Name of Emergency Contact
Please put the full ten (10) digit phone number for your Emergency Contact.
Secondary Phone Number for Emergency Contact
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