Step 1 of 4: Passenger Contact Information

First Name*

Last Name*

Sex

Primary Language

Street Address*

City*

Zip*

State*

Phone*

Your Email*

Do you have mobility needs?

Example: wheelchair

Step 2 of 4: Service Animals

Do You Have Service Animals?

If yes how many?

If yes what kind?

Step 3 of 4: Emergency Contact Information

Full Name:*

Phone:*

Relationship:*

Notes:

Step 4 of 4: Legal Information

LEGAL DISCLAIMER LIMIATION OF LIABILITY
BY USING THIS WEBSITE, YOU (“THE USER”) AGREE THAT NEITHER LOWCOUNTRY REGIONAL TRANSPORTATION AUTHORITY, OPERATING AS PALMETTO BREEZE (HEREINAFTER REFERRED TO AS “THE AUTHORITY”) AND ITS AFFILIATED COMPANIES, NOR THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS, OR SUPPLIERS, SHALL HAVE ANY LIABILITY TO YOU UNDER ANY THEORY OF LIABILITY OR INDEMNITY IN CONNECTION WITH YOUR USE OF THIS WEB SITE. YOU HEREBY RELEASE AND FOREVER WAIVE ANY AND ALL CLAIMS YOU MAY HAVE CURRENTLY OR IN THE FUTURE AGAINST THE AUTHORITY AND ITS AFFILIATED COMPANIES, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS OR SUPPLIERS (INCLUDING BUT NOT LIMITED TO CLAIMS BASED UPON THE NEGLIGENCE OF THE AUTHORITY AND ITS AFFILIATED COMPANIES, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS, OR SUPPLIERS) FOR LOSSES OR DAMAGES YOU SUSTAIN IN CONNECTION WITH YOUR USE OF THIS WEBSITE.
NOTWITHSTANDING THE FOREGOING PARAGRAPH, THE TOTAL LIABILITY OF THE AUTHORITY AND ITS AFFILIATED COMPANIES, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS AND SUPPLIERS, IF ANY, SHALL NOT EXCEED THE FEES PAID BY THE USER FOR THE PARTICULAR INFORMATION OR SERVICE PROVIDED. NO CIRCUMSTANCES SHALL THE AUTHORITY AND ITS AFFILIATED COMPANIES, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS OR SUPPLIERS BE LIABLE TO YOU FOR ANY LOSSES OR DAMAGES IN EXCESS OF THE AMOUNT REFERRED TO IN THE PRECEDING SENTENCE. ALL OTHER DAMAGES, WHETHER DIRECT OR INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE, ARISING FROM ANY USE OF THE WEB SITE, ARE HEREBY EXCLUDED, EVEN IF THE AUTHORITY AND ITS AFFILIATED COMPANIES, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, INFORMATION PROVIDERS OR SUPPLIERS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
IT IS SOLELY THE USER'S RESPONSIBILITY TO PROVIDE CORRECT INFORMATION, UPDATE INFORMATION, HAVE THE ABILITY TO UTILIZE BOTH TRANSPORTATION SERVICES AND SHELTERING SERVICES. IN NO WAY DOES THE ENTERING OF THIS INFORMATION INTO THE TRANSPORTATION ASSISTANCE REGISTRY LIMIT THE RESPONSIBILITY OF THE USER TO CONFIRM THE AVAILABILITY OF TRANSPORTATION SERVICES. USERS ARARE REQUIRED TO CONTACT THE AUTHORITY TO CONFIRM THEIR NEED FOR TRANSPORTATION SERVICES DURING AN EMERGENCY EVACUATION. INDIVIDUALS WHO REGISTER ARE NOT GUARANTEED TRANSPORTATION SERVICES.
THE FOLLOWING INFORMATION IS PROVIDED BY SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL (SCDHEC) AS GUIDANCE FOR AMERICAN RED CROSS SHELTERS INCLUDING EMERGENCY MEDICAL SHELTERS. PLEASE NOTE THE AUTHORITY VEHICLES ONLY TRANSPORT EVACUEES TO DESIGNATED AMERICAN RED CROSS SHELTERS. IF YOU CANNOT UTILIZE THE SHELTER FACILITIES AVAILABLE, TRANSPORTATION SERVICES WILL NOT BE PROVIDED TO OTHER DESTINATIONS.

I have read and accept the terms and conditions of this legal disclaimer.*

[recaptcha]