Proviso Township Transportation Client Agreement

Township vehicles are not wheelchair accessible and all clients are required to walk without driver assistance. Drivers will not assist clients with walking and/or getting in and out of the vehicle.

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All clients must be ready for pick-up 15 minutes prior to their scheduled time. Drivers are allowed to wait only 5 minutes after they arrive, to ensure they stay on schedule.

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Clients cannot ask the drivers to enter driveways, make unscheduled trips, and assist with walking or to carry packages. There is a 4-bag maximum per client/trip. Clients must be able to handle/carry all packages without driver’s assistance.

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All clients must call the office prior to 3:00 p.m. to ensure a return trip.

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All appointments must be scheduled at least 2 business days (weekends not counted) and up to 4 weeks in advance. Last minute requests will not be honored.

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Clients must provide a minimum of 24 hours’ notice when canceling a scheduled appointment.

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Clients may have another individual 21 years of age or older accompany them.

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Clients with a neurocognitive disorder and/or physical disability are required to have someone assist them.

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All clients are allowed one round-trip per day.

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All clients must always wear seatbelts while riding in Township vehicles. Those who refuse will forfeit their ride privileges.

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It is prohibited to smoke, eat and drink, curse, or exhibit rude, inappropriate behavior towards staff and/or other clients.

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I acknowledge that, in consideration of both our drivers and other riders, we require clients to maintain a high level of cleanliness when using the service.

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I acknowledge that, due to the large number of clients in our program, wait times may vary.

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*We assure you that every effort is made to bring a meaningful service to as many senior residents as possible in the Township.

BY PRINTING YOUR NAME BELOW, THE REQUESTOR AGREES TO THE TERMS AND CONDITIONS OUTLINED IN THIS REQUEST. NON-COMPLIANCE MAY RESULT IN THE DENIAL OF REQUEST. ELECTRONIC/TYPED SIGNATURE IS EQUIVALENT TO AN ORIGINAL SIGNATURE AND IS EVIDENCE THAT YOU AGREE TO BE BOUND BY THIS.

Client's First and Last Name:

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Confirm client's first and last name:

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Date: {{ $now.format('MM-dd-yyyy') }}

Please complete the registration process by attaching:

Proof of Age (ID, Driver's License):

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Proof of Residency (Utility Bill, Social Security Statement, etc):

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Proviso Township
Senior Services Department
4565 Harrison Street, Hillside, IL 60162
FAX: (708-202-1265) Email: Lrizzo@provisotownship.illinois.gov

Proviso Township Transportation Client Agreement

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