Rider Acknowledgment and Waiver Form

Program Overview:

UpLift provides free transportation to mental health, medical, and essential service appointments for individuals experiencing transportation barriers.

Rider Agreement:

By signing below, I acknowledge and agree to the following:

• I understand that UpLift is a free service and is provided as a courtesy to help me attend important health-related appointments.

• I understand that UpLift drivers are not medical providers or emergency personnel, but they are trained in CPR, First Aid, and crisis de-escalation.

• I will be respectful and cooperative with my assigned driver at all times.

• I will notify UpLift staff as soon as possible if I need to cancel or reschedule a ride.

• I understand that repeated missed rides without notice may affect my eligibility to use the service.

Assumption of Risk and Release of Liability:

• I voluntarily agree to participate in the UpLift program and understand that, as with any transportation, there are inherent risks.

• I agree to hold harmless and release UpLift, its parent organization Affirming Heart Victim Services, its employees, volunteers, and agents from any and all liability, claims, or damages arising from my participation in the program, except in cases of gross negligence or intentional misconduct.

Confidentiality Notice:

• My personal information and ride details will be kept confidential and used only for service coordination purposes unless required by law (e.g., mandatory reporting).

Medical Emergencies:

• I understand that drivers cannot provide medical care but are trained in CPR, First Aid, and crisis de-escalation, and will call 911 in the event of a medical emergency or safety concern.

Consent to Participate:

By signing below, I confirm that I have read, understood, and voluntarily agree to the terms outlined above.