Application for transport

Service

Please choose the service from the drop-down list below

Declaration

School/applicant email:*

information icon If you are a parent / carer and feel your child requires transport due to an ASN, Temporary Medical Condition or a Split Placement please contact your child’s education establishment to discuss this further.

Please ensure you have read and understand the School Transport Policy and the e-form User Guide prior to completing this form School Transport Policy (north-ayrshire.gov.uk)

Please note, the User Guide details all the mandatory information required in order to submit this form.

I have read and understood the Transport Policy and Guidance document before submitting this application form:* Yes No

The North Ayrshire Council remind you that you are responsible for your child’s behaviour while on transport and to ensure that a responsible adult, as appropriate, accompanies your child to the designated pickup and drop off point at the allocated times. Transport may be withdrawn in the event that your child’s behaviour is unsuitable; transport may be reinstated when a formal agreement is reached on future behaviour.

Requestor/applicant details

Authorisation from a senior manager (please note, applications without the relevant authorisation will be rejected):

Name:*

Designation:*

Email:*

Contact telephone number:*

Work base location (team, school, establishment, etc):*

Contact details

First name:*

Last name:*

Email:*

Home telephone number:*

Daytime telephone number:*

Emergency contact telephone number:*

Mobile telephone number (this may be used for SMS alerts relating to the Service Users transport):

Nature of parent/carer medical condition, please specify:

Parent/carer completing the form

First name:*

Last name:*

Email:*

Work telephone number:

Employee completing the form

First name:*

Last name:*

Email:*

Work telephone number:

Date (dd/mm/yyyy):*

Medical/health Condition

Only pupils living within the catchment area will be considered for transport, other than in exceptional circumstances.

Nature of medical/health condition (please specify):

Letter from GP/Consultant attached in support of request? Please attach if yes:* Yes No

Attach file (max 5mb in size):*

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Service user address

Enter your address and choose the correct entry from the list:*

Service user details

First name:*

Last name:*

Date of birth (dd/mm/yyyy):*

Gender:*

Other:

Pupil passport

In the vehicle I like:*

In the vehicle I don't like:*

Things that work well with me:*

Care plan - health need:* Yes No

I am capable of wearing a face mask:* Yes No

I am capable of physically distancing:* Yes No

Additional Information:

Risk assessment/health care plan

Does the Service User have a risk assessment? Please attach if yes:* Yes No

Attach file (max 5mb in size):*

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Does the Service User have a health care plan? Please attach if yes:* Yes No

Attach file (max 5mb in size):*

Browse Please select a file to attach...

Passenger Transport Assistant

Could the Service User require medical intervention during transport (a Passenger Transport Assistant must travel with them)?:* Yes No

Has a risk assessment identified a need for a Passenger Transport Assistant with specific medical training to travel with the Service User?:* Yes No

Has a Passenger Transport Assistant been recruited to travel with this Service User?:* Yes No

Training requirements

Core and mandatory training can be requested to assist external and internal transport providers.

Mandatory training

Adult/Child Protection
Communication

Specific training requirements

Please select from the options below (formal or briefing):

Dealing with Challenging Behaviour (ASN) or (Social and Emotional)
Supporting Young People with Autism
Moving and Handling

Other (please specify):

How we will look after your information

In order to process your application it is necessary for North Ayrshire Council to ask you for personal data. This information will only be used for the purposes of school transport and will not be used for any other purposes. We may share your information with external transport providers, including Strathclyde Partnership for Transport and other local authorities, but only for the purposes of providing school transport. In addition, it may be necessary to share your information with other public bodies when required to do so by law for the prevention and detection of crime or the protection of children. We will ensure your information is kept safe and secure and that we will comply with the Data Protection legislation. For further information about your rights to access information we hold on you and to view our privacy policy statement visit our website: http://www.north-ayrshire.gov.uk/privacy-policy.aspx. Should you wish to speak to someone for further information please contact the Corporate Transport Hub on 01294 541613.

Confirmation

I confirm that all of the information provided above is true and accurate at the time of submitting this form:* Yes No

North Ayrshire Council