Our Privacy Statement.
Name:
Date of birth:
Address:
Telephone Number:
Emergency Contact Telephone:
Email address:
Can you explain why you can't use public transport, so that our service can meet your needs:
Do you use a wheelchair? Yes No
If 'yes' will you need to travel on the bus in your wheelchair? Yes No
Can you transfer to a seat for the journey? Yes No
Is your wheelchair an electric wheelchair? Yes No
Are you able to hire a wheelchair instead of taking your own? Yes No
Will you need a carer to travel with you? Yes No
Do you have your own carer? Yes No
Click the 'Submit' button below to send your form to County Durham Care. Durham County Council is the Data Controller for the purposes of the Data Protection Act.
Alternatively, you can print this page, complete the details and send the form to:
County Durham Care Priory House Abbey Road Pity Me Durham DH1 5RR
These guidance notes are to help you fill in the Access Bus membership form. We have explained why we need the information for each section.
Please give your name, address and telephone number so that we can call you or send you information about trips and days out. This is also useful when we need to send you questionnaires or posters. Your date of birth is useful for analysis. With this information we can find out which age groups use the Access Bus. By providing emergency contact information, we have someone we can contact if you are ill on a trip.
We need to know why you can’t use public transport. This means we can make our service meet your needs, it also lets us know some of the reasons why people like to use our service.
If you travel on the bus in your wheelchair, it does not create any difficulties, but we need to arrange to have the wheelchair fixed at the back of the bus. If you can use one of the seats instead of your chair, this creates more space. This means more people can use the bus. We need to know if your chair is an electric wheelchair as this takes up more space than other chairs. In some of the places that we visit you can hire a wheelchair, such as the Metro Centre. We will let you know when you book your trip if you can hire a wheelchair.
You are very welcome to have a carer, friend or relative travel with you, but you do need to book a place for them.
Click here to return to the application form
