Hays Ride | Request a Ride to the Polls

Voter first name *

Voter last name *

Voter email * I don't have an email

Phone number *

Cell Home

Voter date of birth *

Are you requesting the ride for yourself or on behalf of the voter?

I am the voter I am completing this form for the voter

Address where you are registered to vote *

Start typing a Hays County, Texas address.

Is the pickup address the same as the voter registered address?

Yes No

I have verified that the above is the correct address *

Select one date. *

Pickup window

Early pickup time *

Latest pickup time *

Select any alternate dates you are potentially available.

Additional voter

Additional passengers (non voters)

No. of adults

No. of children

Additional support needs

Does the voter require language assistance? *

How did you learn about our service? *

Any additional details?

The next step is the rider agreement. You must read it and sign before review.

I have read this agreement, I understand it, and I sign it as a waiver of liability. *

Printed legal name *

Draw your signature *

Request A Ride