Register for our community transport services


CONTACT DETAILS

Please use the following format: dd/mm/yyyy

Please give details of someone we can contact on your behalf in an emergency.


TELL US ABOUT YOURSELF

Please check all the statements that apply to you

Do you use a walking aid?

If you use a scooter please provide details of the make and model. We need to ensure that your scooter can be transported safely and unfortunately we are not able to accommodate Class 3 scooters which are not designed for use on the road.

Please note that for safety reasons it is not possible for you to remain on your scooter on the passenger lift or inside the vehicle. For this reason you will be need to be able to use the passenger lift or the side entrance independently.

If you use an electric wheelchair please provide details of the make and model. We need to ensure that your wheelchair can be transported safely.

Please note that it will be necessary to disengage the drive clutches on the wheels of your electric wheelchair when boarding and alighting.


MONITORING INFORMATION

How did you hear about Sheffield Community Transport?

What is your ethnicity?


DECLARATION

Please tick the statements below to confirm that:


SCT uses the personal information you supply in this form in order to assess your eligibility to use our services. If you are eligible we will enter the data you provide into our transport scheduling and accounting software. The information you provide will be used solely to allow us to provide transport which matches your requirements. Your data will be securely stored on our system which is password protected. There may be times when we need to write to you about the service we provide for you. In this instance, we may share your information with an appointed third party supplier to manage fulfilment on our behalf. Any appointed supplier will be thoroughly screened on their data protection credentials, and we will ensure your data is removed as soon as any fulfilment is complete. SCT will never share your details with any other person or agency without your written permission. If you no longer wish to use our services we will anonymise all your personal details in the system. Once this has been done the information cannot be retrieved.

We do need your consent to store any of your personal data on our system so, if you are willing for us to do this, please tick the box below.

I consent to Sheffield Community Transport holding personal information about me on their computer system. I understand that this data is used by SCT solely for purposes related to the provision of transport. I understand that this data will never be shared with any third party except as stated above.