coronado seniors out and about rider enrollment...

“A Transportation Option for Coronado Residents 60+”

Coronado Seniors Out and About is supported by:

John D. Spreckels Center and Bowling Green ● Phone: (619) 522-7343 ● www.coronado.ca.us/outandabout

Coronado Seniors Out and About Rider Enrollment Packet:

Thank you for your interest in becoming a rider with the Coronado Seniors Out

and About program! We serve the needs of Coronado residents 60+ who have

limited transportation options. Enclosed are the necessary forms for enrollment;

please read through the packet below and complete the checklist. Any questions

can be answered by calling (619) 522-6302.

Coronado Seniors Out and About Program Information

Rider Application

Program Waiver

Driver Evaluation Form



The City of Coronado provides municipal services to a population of approximately

25,000 residents on the peninsula between the Pacific Ocean and San Diego Bay.

The City of Coronado is a small beach community with an island feel. It was

incorporated in 1890. The City aims to provide community building and recreational

opportunities to citizens and visitors through the Coronado Recreation Services

Department, which serves as the lead department for the implementation of the

Coronado Seniors Out and About Program.

The mission of the Coronado Recreation Services Department is to strengthen

community through programs, services, and facilities that enhance personal

development, promote healthy lifestyles, encourage community involvement, and

foster environmental stewardship. The Department's major emphasis is providing

opportunities for personal enrichment, development, fitness and wellbeing for

people of all ages. Recreation services are provided at many locations, including the

Coronado Community Center and the John D. Spreckels Center and Bowling Green,

among others. A variety of classes and services are offered, including adult

education, senior programs, youth camps, fitness classes, boating, kayaking, tennis,

and aquatics. The City of Coronado Recreation Department is committed to serving

the needs of everyone in the community through inclusive programming, providing

an atmosphere in which persons with and without special needs can interact, play,

and socialize with their peers in an all-encompassing social environment.

The Coronado Seniors Out and About transportation program is supported by

SANDAG as part of the TransNet Senior Mini-Grant Program This project supports strategies of the Coordinated Plan, the regional strategy to

provide transportation to recognized transportation disadvantaged groups including

seniors, individuals with disabilities, and persons with limited means.

Coronado Seniors Out and About (CSOA)

Coronado Seniors Out and About (CSOA) is a volunteer driver program that

provides advanced scheduled rides for a nominal fee ($1 to $4 depending on

distance traveled) to adults 60 years and older to destinations in Coronado and San

Diego. Volunteer drivers are screened by the City of Coronado’s Senior Out and

About program to ensure they meet the qualifications to become a Volunteer

Driver.

There are two ways to participate in Coronado’s Senior Out and About program:

become a volunteer driver or become a rider.



Rider Eligibility:

Rider must be 60 years or older

Reside in Coronado and have limited or no transportation

Must be able to walk on their own or with a walker or cane

If rider needs assistance with transfers to and from a wheelchair, they must

have a caregiver enrolled in the program. Contact program staff for

information.

The City of Coronado reserves the right to determine rider eligibility

Types of Rides:

Curb to Curb for riders who are fairly agile and independent

Door to door for those who need some assistance

Door through door, when the riders request the volunteer stay by their side

Fees:

Fees are based on the exact pick up and drop off location. See Fee Schedule below.

Once enrolled into the program, riders will be invoiced monthly. Payment is due

within 14 days of invoice. If there are any questions or concerns regarding fees or

payment, riders should contact the CSOA program for assistance. Payments can

be made to:

City of Coronado Recreation

Attn: CSOA

1019 Seventh Street

Coronado, CA 92118

Where We Go!

Participants can schedule a ride to any medical or personal event or errand within

the City of Coronado and into San Diego County up to 25 miles.

FEES per Mile:

1 mile to 6 miles = $1.00

6+ miles to 12 miles = $2.00

12+miles to 18 miles = $3.00

18+ miles to 25 miles = $4.00



Hours of Operation:

Scheduled rides are provided Monday through Saturday, 8:00 a.m. until 5:00 p.m.

Rides can also be scheduled for certain special events within the City of Coronado.

Speak to CSOA program staff for a special events or holiday requests.

Enrollment:

Read the Program Information Packet

Complete and sign the Rider Application

Read and sign the Rider Waiver

Mail your application to:

City of Coronado Recreation

Attn: CSOA

1019 Seventh Street

Coronado, CA 92118

Within a week of the receipt of your completed and signed application packet, the

Coronado Seniors Out and About program will contact you to complete your

registration. This final step includes detailed questions regarding your mobility,

special requests, and your needs during the ride. These questions are asked to ensure

the Volunteer Driver provides a safe, comfortable and enjoyable ride for you. Your

information will be input into our RideScheduler system. All information collected

will be kept confidential.

Scheduling/Canceling Rides:

To schedule a ride, call 619-522-6302 Monday through Friday, 9:00 a.m. to 5:00

p.m.

Because every Rider enrolled has already been entered into the RideScheduler

System, scheduling rides is easy and will go as follows;

A Rider calls in to schedule a ride

The details of the ride are entered into RideScheduler

A Volunteer Driver logs into RideScheduler to see what rides are

needed on the day he/she is available to give a ride.

The Volunteer Driver signs up to provide the ride, then contacts the

rider via telephone.

Staff manages the daily operation of rides being scheduled. If there

is no Driver available for a Rider, the Rider will be notified of the

cancellation with a minimum of 24 hours’ notice during regular center

business hours.



Rides are required to be scheduled at least one week in advance

Rides can be scheduled up to one month in advance

Riders must be prepared to depart at the requested pick-up time

•

A minimum of 24 hours’ notice for scheduled Tuesday through Friday rides and 72 hours’ notice for Monday rides are required to cancel. Notice must be given to the CSOA office at (619) 522-6302 Monday through Friday, 9:00 a.m. to 5:00 p.m.

If there is a problem or concern with a Volunteer Driver, Riders should call

the CSOA office at (619) 522-6302 to notify the staff.

Tipping is not allowed. Those Riders who would like to donate money may

donate directly to the program. Please speak to a Coronado Seniors Out and

About program staff member if you are interested in donating to the CSOA

program

Seat belts must be worn at all times.

The City of Coronado and the Coronado Seniors Out and About Program are

not responsible for any lost, stolen or missed items during your travel.

Traffic over the bridge should always be a consideration when scheduling

rides. When scheduling, please allow extra time for travel, particularly during

high traffic times.

For medical appointments, please confirm the anticipated length of the appointment before contacting staff to schedule a ride.

Updated 10/31/2016




Driver Evaluation Form

Your Name: Phone:

Driver’s Name: Date of Ride:

Please rate the following:

Excellent Good Fair Poor

Timeliness of pickup

Timeliness of drop off

Comfort of ride

Cleanliness of vehicle

Safety of vehicle

Adherence to traffic laws

Friendly and Courteous

Overall Driver Rating

How can we improve your next ride?

Would you recommend the Coronado Seniors Out and About program to others? Yes No

Updated 10/31/2016




Rider Application

Applicant Information

Full Name: Gender: Male Female Last First M.I.

Address: Street Address Apartment/Unit #

City State ZIP Code

Home Phone: Alternate Phone:

Email: Date of Birth:

How did you hear about Coronado Seniors Out and About Program?

Advertisement Friend/Family Presentation Banner Flyer Other

If Other, please describe:

In order to better serve you, check all below that apply:

X Mobility Aids X Health

Cane Vision Impaired Walker (light weight) Hearing Impaired Walker (with seat) Oxygen Tank Collapsible Wheelchair Non-Ambulatory Non-collapsible chair/Scooter Other: Other:

If you use a wheelchair, can you self-transfer and walk independently? YES NO

Do you require physical assistance?* YES NO

*If assistance is needed, a certified caregiver must accompany the rider.

If yes, please describe:

Preferred Language:

Coronado Resident? Yes No

Updated 10/31/2016 Coronado Seniors Out and About is supported by:


The following questions are voluntary and will assist us in meeting grant reporting requirements.

What led you to apply for this program?

Do not have a valid driver’s license Unable to drive

Do not have a vehicle Have a disability

Other:

What form of transportation are you currently utilizing?

Emergency Contact Information

Full Name: Last First Relationship

Address: Street Address Apartment/Unit #

Phone: Alternate Phone:

Voluntary Questionnaire

The following questions are for statistical purposes only. Your response is voluntary and has no bearing

on your eligibility.

Race: Asian/Pacific Islander African American

American Indian/Alaskan Native Hispanic

White/Non-Hispanic Other

Income: Less than $22,050 More than $22,050

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

I understand that false or misleading information in my application or interview may result in my release

or eligibility from this program.

Signature: Date:

Updated 10/31/2016




Read This Document Completely Before Signing

Coronado Seniors Out and About Program Waiver of Liability and Express Assumption of the Risk

RELEASE FROM LIABILITY: In consideration of the acceptance of myself to be a participant

(as either a driver or a rider) in the Coronado Senior’s Out and About Program (hereinafter referred

to as "the Program"), I, _________________________ (name) expressly agree and knowingly

assume all risks arising in the course of the Program, including but not limited to, personal injury,

property damage or death, on behalf of myself, my heirs, executors, administrators, and assigns,

and hereby voluntarily release, discharge, waive and relinquish any and all claims and causes of

action from personal injury, property damage or wrongful death against the City of Coronado, its

agents, officers, and employees which may occur during my participation in the Program.

I hereby agree for myself, my heirs, administrators, executors and assigns that I shall indemnify

and hold HARMLESS the City, its agents, officers and employees for any injury, death or damage

to or loss of personal property arising out of, or in connection with, my participation in the

Program. I also hereby agree, for myself, my heirs, administrators, executors and assigns, that I

shall indemnify and hold harmless the City of Coronado, its agents, officers, and employees from

any and all claims, demands, actions or suits arising out of or in connection with my participation

in the Program, including any and all claims, loss, damage and liability for injury to their person

or property or another or others, directly or indirectly caused by any misfeasance or malfeasance

by me occurring while participating in the Program. This release is intended to discharge in

advance the City of Coronado, all other city agencies and/or any of their agents, volunteers or

employees by reason of any accident, death, injury or damages to persons or property which I may

suffer, from and against any and all liability arising out of or connected in any way with my

participation in the Program, even though that liability may arise out of negligence or carelessness

on the part of the persons or entities mentioned above.

CODE OF CONDUCT: In consideration of the benefits of the program, I agree to abide by the

Code of Conduct set forth in this section. I understand that this Code of Conduct ensures the quality

and safety of the program, and that all program participants, staff, and volunteers are required to

abide by this Code. The Code of Conduct states that: "All persons shall act with respect toward

others, observing their privacy and safety. Physical or verbal abuse of any kind will not be tolerated

and will result in the participant being asked to leave the program. All persons shall show respect

Updated 10/31/2016



to the property of others; intentional damage to, or theft of, such property or program equipment

will result in the participant being asked to leave the program. Program rules and regulations shall

be observed at all times. While staff is committed to having the participant enjoy the experience,

inappropriate behavior may result in a participant being asked to leave. Drugs and alcohol affect

the ability to drive or operate a motor vehicle and all drivers understand and agree that the use of

any drug or alcohol which may affect their driving ability. As such, the use of drugs and/or alcohol

prior to 8 hours before participating as a driver in the Program is strictly prohibited. This includes,

but is not limited to, prescription, or “over-the-counter” medication and alcohol and all drivers

understand and agree to not use any drug or alcohol that may affect their driving ability." No

refunds will be given in the event that a participant is asked to leave the program for violating the

Code of Conduct.

VIDEO AND PHOTOGRAPH RELEASE: I understand and agree that the City of Coronado

reserves the right to take and use videos and photos of participants, free of charge, to be used for

publicity purposes in the City's program guide and/or other media publications.

ELDER ABUSE MANDATED REPORTERS: I understand that City Parks and Recreation

Department staff may be required by state law to report any suspected cases of elder abuse or

neglect to the appropriate authority for investigation.

I, the undersigned, have read and understand the information listed above:

PARTICIPANT NAME: DATE:

PARTICIPANT SIGNATURE:

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