Guaranteed Ride Home Registration

1. Transportation, Engineering and Development Business Group

Please be sure to complete all fields in the form below. If you have any questions or concerns, contact the Naperville Commuter Call Center at (630) 305-5330.

Please note: Only one (1) applicant/signature per registration will be accepted. Additional applicants must complete separate applications. The Naperville resident whose electronic signature appears on this registration application will be considered the Guaranteed Ride Home (GRH) participant and responsible party.

All fields marked with an asterisk (*) are required and must be completed before submitting the form.

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* 1. Name

First Name

Last Name

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* 2. Address

Street Address

City

ZIP Code

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* 3. Contact Information

E-mail Address

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* 4. Identification Card (please provide one of the following)

Driver's License Number

State ID Number

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* 5. Train Station (pick one)

Route 59 Station

Downtown Naperville Station

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* 6. Pace Bus Route Number

I have read and understand the Rules and Regulations of the Guaranteed Ride Home (GRH) Program (as amended from time to time) and I hereby agree to abide by them. I acknowledge that my participation in the GRH Program is voluntary and my enrollment can be discontinued at any time. Further, I understand and acknowledge that cab drivers I choose to hire for transportation are not employees or contractors of the City of Naperville.

Release and Waiver of Liability: In consideration of my being allowed to participate in the GRH Program, I hereby voluntarily agree to release, discharge and hold harmless the City of Naperville and its officers, agents, employees, and representatives from any and all liability, claims, demands, actions and causes of action of any kind arising out of, or in any way related to, any aspect of my participation in, or the operations of, the GRH Program whether such claims, demands or causes of action are known or unknown, and whether they are direct or indirect, including but not limited to any and all injuries or damage to me or my property, and injuries or damage to property of others.

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* 7. I have read and understand this Release and Waiver of Liability and agree to be bound by it.

Yes

Only one (1) applicant per registration will be accepted. Additional applicants must complete separate applications. The Naperville resident whose name appears on this registration application will be considered the GRH participant and responsible party.