Northwest Valley Connect
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Rider Resources

Enrollment

New riders. age 65 or older, veteran, or disabled must complete and submit a Rider Enrollment Application

It’s as easy as 1 –  2 – 3

OPTION 1

Use the ONLINE Rider Registration Form
— OR —

OPTION 2

DOWNLOAD the Rider Enrollment Packet HERE
— OR —

OPTION 3

Call 623.282.9300 to request a registration packet

P
Q

Participating in Olive Branch Senior Program?

- Rider must live within 6 miles of the center and fully enrolled with us to use our transportation.

- Rider must be 65 or older, a veteran or disabled.

- Rider must give 7 days notice to place a ride request

RIDES ARE NOT GUARANTEED

Rider will be notified 3 days in advance of their date request to confirm if a volunteer is available for them.

P
Q

Are you an El Mirage resident?

- For a small fee, residents of El Mirage are able to have their Lyft rides scheduled and coordinated by NVC.

- In addition to Lyft, we provide transportation in NVC accessible vehicles for residents who are disabled and cannot utilize the Lyft program for the same low fee of $2.00 each way.

- Rider must give 2 days notice to place a ride request

RIDES ARE NOT GUARANTEED

P
Q

Are you a resident of the city of Surprise?

- Rider must be 65 or older, a veteran or disabled.

- Rider must give 7 days notice to place a ride request

RIDES ARE NOT GUARANTEED

Rider will be notified 3 days in advance of their date request to confirm if a volunteer is available for them.

P
Q

ALL OTHER RIDERS IN DESIGNATED SERVICE AREAS

- Rider must give 7 days notice to place a ride request

RIDES ARE NOT GUARANTEED

Rider will be notified 3 days in advance of their date request to confirm if a volunteer is available for them.

RIDER ENROLLMENT

Online Application

If you prefer to print, manually complete and mail in the application, you can download the packet by clicking on the button below.

IMPORTANT: You must be 65 or older to enroll.

DOWNLOAD ENROLLMENT PACKET

APPLICATION

EMERGENCY CONTACT

If you utilize a wheelchair, can you self-transfer and walk independently?

CAREGIVER

If you need physical assistance, an enrolled Caregiver must accompany rider.

In order to better serve you, please check all that apply.

If "Other," please describe below:

Please check all that apply

If you selected "Other" please briefly describe:

RIDER DEMOGRAPHICS

The data requested on this page is for statistical purposes only and helps NVC to obtain foundation and government funding to keep our programs running.

HOUSEHOLD INCOME

HOUSEHOLD ANNUAL INCOME BELOW
1 $21,870
2 $29,580
3 $37,290
4 $45,000

Rider Agreement

Please read, agree, and digitally sign. This is required in order for you enrollment to be approved.


  • Northwest Valley Connect is designed for individuals with limited transportation options.

  • Northwest Valley Connect reserves the right to determine rider eligibility.

  • Please notify the Northwest Valley Connect office of ride cancellations with at least 24-hours  notice. Please note that excessive cancellations may result in dismissal from the program.

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

  • Riders must be mentally alert and ambulatory or able to self-transfer into and out of the vehicle. If not, caregiver enrollment Is required.

  • Please do not tip the Drivers. Riders who would like to make a tax-deductible donation may contribute through the NVC website: NorthwestValleyConnect.org;  by phone (623) 282-9303; or by mail: PO Box 9303, Surprise, AZ 85374.

  • If there is a problem or concern, riders should call Northwest Valley Connect immediately at 623-282-9300.

Enter your full name

EL MIRAGE RESIDENTS ONLY



Dial a Ride Trips:  Phone #623-282-9300



  • A minimum advance notice of 2 days is required for all ride requests.

  • The fare per ride is $2 for each ride (one way) and will be invoiced to you at the end of each month.  Payment is due upon receipt of the invoice.  If payment is not received within 30 days, service will be suspended until payment is received.

  • Northwest Valley Connect and the City of El Mirage reserve the right to determine rider eligibility.

  • Trips will be booked on Lyft for all ambulatory persons.

  • Accessible trips (wheelchair bound and those needing extra assistance) will be provided by NVC drivers.

  • Medical trips booked for outside of the Dial a Ride map area will need to be pre-approved by NVC and the City of El Mirage.

Release and Waiver of Liability and Indemnity Agreement

In consideration of my voluntary participation in a NVC transportation program, I, the undersigned, hereby agree to the following:

  • I hereby release, waive, indemnify and hold harmless Northwest Valley Connect, its Directors, Officers, employees and volunteers from any loss, liability, and damage due to my voluntary participation in the transportation program.

  • I hereby assume full responsibility for the risk of bodily injury, death or property damage.

  • I further agree that the foregoing Release and Waiver of Liability and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Arizona, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

  • I have read and voluntarily signed the Release and Waiver of Liability and Indemnity Agreement, and further agree that no oral representations, statements or inducements, apart from the foregoing written agreement, have been made.

Date/Time Digitally Signed
12/4/2023 9:56 PM

Media Release

RELEASE:


I, the undersigned, give permission to Northwest Valley Connect (hereafter referred to as “NVC”) to use, reproduce, distribute and/or display videos, photographs, or audio recordings to use for NVC’s marketing and promotions.

I acknowledge and agree that NVC may use the media in various formats and through different channels, including but not limited to, websites, social media platforms, advertisements, broadcasts, publications and any other promotional or educational materials in any medium.

I understand that I will receive no payment or other compensation for the use of the media.

I release and discharge NVC and its agents, representatives and assignees from any claims, actions, damages, costs, or liabilities of any kind, whether in connection with the use of the media or otherwise.
Date/Time Digitally Signed
12/4/2023 9:56 PM

Resources

TITLE VI PLAN (Civil Rights)

Download Forms and Notices

Title VI Civil Rights Notice to the Public
and Policy Statement

Northwest Valley Connect hereby gives notice that it is the agency’s policy to assure full compliance with Title VI of the Civil Rights Act of 1964 and related statutes and regulations in all programs and activities. These federal statutes require that no person shall, on the grounds of race, color, or national origin be excluded from the participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program, activity or service.

Title VI Notice to Public

Title VI Notice to Public – English

Title VI Notice to Public – Spanish

Title VI Complaint Procedures

Title VI Complaint Procedures – English

Title VI Complaint Procedures – Spanish

Title VI Complaint Form

Title VI Complaint Form – English

Title VI Complaint Form – Spanish

Title VI Implementation Plan

Title VI Implementation Plan for 2021 – 2024

AMERICAN DISABILITIES ACT (ADA)

Download Forms and Notices

ADA Rights Notice to the Public
and Policy Statement

Northwest Valley Connect hereby gives notice that it is the agency’s policy to assure full compliance with Title II of The Americans with Disabilities Act (ADA) of 1990 and related statutes and regulations in all programs and activities. These federal statutes require that no person shall, on the grounds of disabilities be excluded from the participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program, activity or service.

ADA Notice to Public

ADA Notice to Public – English

ADA Notice to Public – Spanish

ADA Complaint Procedures

ADA Complaint Procedures – English

ADA Complaint Procedures – Spanish

ADA Complaint Form

ADA Complaint Form – English

ADA Complaint Form – Spanish