I am happy to receive information on behalf of the passenger
Mobility & Additional Needs
When travelling, will you be using any of the following? (Please tick Box)
Wheelchair Sticks/Crutches Folding Frame Rigid Frame
Please give details of your Disability or State of Health
How did you hear of our transport scheme?
Terms & Conditions:
Please note:
Bus passes cannot be accepted in our volunteer cars and/or DAR Minibuses – there is a fare to pay.
Please allow 15 minutes either side of your pick-up times in case of traffic.
Please contact us as soon as possible to cancel your trip to avoid unnecessary costs.
I acknowledge that Epping Forest (incorporating Harlow) Community Transport is a non-profit
making organisation and depends greatly on services provided by volunteers.
I understand that while every effort will be made to provide me with transport as requested, there
may be occasions when the service is limited or unavailable & that I should prepare to be flexible
when booking my trip.
I accept that payments will be by monthly invoice, an account being opened under a unique
reference number linked to my name.
I understand that bus passes can only be accepted on minibus travel and not in cars.
I acknowledge that all trips cancelled on the ‘Day of travel’ will incur a cancellation fee of the full
cost of one way travel.
I acknowledge that I am responsible for advising EFCT/HCT of any changes in my circumstances
and/or travel needs.
I declare that the information given on this form is correct to the best of my knowledge.
I give my permission for EFCT/HCT to use appropriate information in the case of an emergency
and when necessary to pass on any relevant information to the driver.
Should you require your carer for travel, then they will need to register separately by completing
their own form.
I confirm that I have read and retained the enclosed terms and conditions