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Please tick all that you require: |  |  |  |  |  |  |  |\n| Walking Stick\u003Cbr>Manual Wheelchair | | Trolley/Walking Frame\u003Cbr>Electric Wheelchair | | Cane\u003Cbr>Mobility Scooter |  |  | |\n| Please note, it is always safer to transfer to a fixed seat for traveling. If you are unable to transfer to a fixed seat, your wheelchair must be certified as safe for travel. |  |  |  |  |  |  |  |\n| Are you able to transfer to a fixed seat? Yes |  |  |  | | No | |  |\n| Prior to your first journey we will arrange for a Mobility Aid Assessment to be carried out , if required, to ensure your aid is safe to be used on our service. Passengers must be able to access the bus independently of mobility scooters as these cannot be driven onto the bus. Electric wheelchairs must be switched to manual and pushed on by the driver. |  |  |  |  |  |  |  |\n\n\n|  |  |\n| --- | --- |\n| Care & Emergency Details |  |\n| Passenger assistants will travel at no extra cost, provided the assistant is necessary for all journeys. Passengers recorded as needing an assistant will not be able to travel without one.\u003Cbr>\u003Cbr>Is a passenger assistant essential for your travel? Yes   No  \u003Cbr>Reason for passenger assistant:\u003Cbr>\u003Cbr>Do you have any medical conditions we need to be aware of?\u003Cbr>Please note, seatbelts must be worn at all times unless you are medically exempt, this will need to be documented with your application.\u003Cbr>Please provide details of an Emergency Contact. This must be someone who will not be travelling with you as a passenger assistant.\u003Cbr>Title First Name Last Name\u003Cbr>|  |\n| | |\n| Postcode Mobile Number Relationship\u003Cbr>|  |\n| Notes on Personal Information |  |\n| • The information on this form will be treated as confidential. The information will only be used to ensure that we provide you with safe and efficient travel.\u003Cbr>• Sometimes passengers’ health or requirements change, you are requested to inform Connect of any change that is relevant to your travel. Occasionally it is not possible for Connect to offer a service for health reasons.\u003Cbr>• Connect information is kept on a computer. We are registered under the 1998 Data Protection Act and work according to the eight principles of the Act.\u003Cbr>• You will be contacted bi-annually for a review of your details and information. |  |\n\n|  |\n| --- |\n| Community First Terms of Service |\n| Introduction\u003Cbr>The following terms and conditions (the “Terms”) apply to our provision and your use of Community First Transport Services (including Connect and Community Transport Hire) . These Terms incorporate a summary of our privacy policy which is also available via our website [https://www.cfirst.org.uk/privacy-and-cookies-policy/](https://www.cfirst.org.uk/privacy-and-cookies-policy/) .\u003Cbr>Please read these Terms carefully. If you do not agree to these Terms, you must not use the Service.\u003Cbr>Your Information\u003Cbr>With respect to your rights and our responsibilities under these terms of service, ‘we’(Community First) will comply at all times with Data Protection Legislation and shall deliver our services in such away as keep your information safe.\u003Cbr>Specifically, we will:\u003Cbr>a) Maintain up to date records of where, why, and how","cbCaikBIeEMNZWbC","https://ap.wps.com/l/cbCaikBIeEMNZWbC","pdf",148639,"English","# Passenger Details\n## Mobility Details\n## Care & Emergency Details\n## Notes on Personal Information\n# Community First Terms of Service\n## Introduction\n## Your Information","[{\"question\":\"Who is eligible to register to use Connect?\",\"answer\":\"Connect is for anyone whose transport needs are not met by public bus services, including people who live too far from a bus stop or have difficulty using public buses. Registration does not require being disabled or using a wheelchair.\"},{\"question\":\"What mobility information does the form request?\",\"answer\":\"The form asks you to tick required mobility aids (for example walking stick, wheelchair, frame, cane, mobility scooter) and to confirm whether you can transfer to a fixed seat. If required, a Mobility Aid Assessment may be arranged before the first journey.\"},{\"question\":\"How are personal information and data protection handled?\",\"answer\":\"The form states that information is treated as confidential and used to provide safe and efficient travel. Community First explains compliance with data protection legislation, safeguards against security breaches, processing based on consent and service needs, and review of details bi-annually.\"}]","Connect Membership Form 2024 - Passenger, Mobility, and Emergency Details | PDF",1789843466]