General Enquiries: 01709 516092 | Booking Centre: 01709 517100
Before you Travel
MiDAS Training Course Content
Before you Travel
MiDAS Training Course Content
Title (eg Mr / Mrs / Miss / Ms)
Date of Birth
Please tick all of the following boxes which apply to you
I need to use a walking aid, e.g. walking stick
I find it difficult to climb steps
I find it difficult to stand for any period
I have a learning disability
I am registered as partially sighted or blind
I have a guide/assistance dog
I receive disability allowance
I use a wheelchair
I find walking difficult
I have a hearing impairment
I have a speech impairment
I receive attendance allowance
I receive a war pensioner’s mobility supplement
Are there any other reasons why you find it difficult or impossible to use public transport for some or all of your journeys?
To help us provide you with the most appropriate service please provide the following information:
If you use a wheelchair please tick which type you would wish to use when travelling on our services
If you use a powered 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 powered wheelchair when boarding and alighting.
If you do use a wheelchair can you transfer to a bus seat?
Do you use a mobility scooter?
Class 2 scooters, no more than 600mm wide and 1000mm long, weighing up to 65kg can be used on Community Transport vehicles. Unfortunately we are not able to accommodate Class 3 scooters which are designed for use on the road.
If you use a scooter please provide details of the make and model. We need to ensure that your scooter can be transported safely.
Please note that for safety reasons it is not possible for you to remain on your scooter on the passenger lift or inside of the vehicle. For this reason you will need to be able to use the passenger lift or the side entrance.
If you use a walking aid please tick which type(s):
If other, please specify:
Can you travel in a car?
If YES do you have any special requirements?
Is there anything which will help our drivers find your address?
Will you need any help to get from your door to the vehicle?
Is there anything else we need to know to ensure you are transported safely and comfortably?
Please give details of someone we can contact on your behalf should the need arise
Relationship (e.g. Son)
How did you hear about Rotherham Community Transport?
Door 2 Door Leaflet
Word of Mouth
I’ve Seen Your Buses
Social Prescribing Project
Connect to Support Rotherham
What is your ethnic group?
Other White Background
Other Chinese Background
Other Asian Background
Other Black Background
White & Asian Dual Heritage
White & African Dual Heritage
White & Black Caribbean
Other Dual Background
Any other ethnic group:
In submitting this application I confirm that:
All the information I have supplied is accurate.
I find it difficult or impossible to use public transport.
I understand that Rotherham Community Transport reserves the right to seek independent medical advice to confirm that I am eligible to receive support.
I accept the conditions of carriage relating to mobility scooters and electric wheelchairs.
I will inform Rotherham Community Transport of any changes in my circumstances which may affect my eligibility to use the community transport services.
I accept that, when deemed necessary, a risk assessment relating to my safety when travelling will be carried out.
How we use your information.
Your personal information will be used by us (including our employees & subcontractors) to assess your eligibility to use our services. If you are not eligible all information will be deleted and the paper registration form will be disposed of. If you are eligible we will enter your data you provide into our scheduling and accounting software to assist us to provide you with the services you ordered and from time to time to communicate with you on any matters relating to the provision of the services we provide. We will not share, sell or distribute any of the information you provide to us unless required to do so by law. 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 a 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. I consent to RCT holding personal information about me on their computer systems. I understand that this data is used by RCT solely for the purposes related to the provision of transport. I understand that this date will never be shared with any third party except as stated above.
Contact the Office
485b Fitzwilliam Road
Telephone: 01709 516092
Telephone: 01709 517100
Contact Telephone Number
© 2022 Rotherham Community Transport