Please give any other details that may help Ring and Ride Registration Fee Registration Form us transport you comfortably. All information To use our services there is an annual registration you give is confidential. fee of £15.00 payable in April. Please make cheques payable to Four Towns & Vale Link Com- munity Transport and send in a sealed envelope

with your name and address.

Emergency Contact Social Car Scheme

Please give a name and telephone number of If Four Towns & Vale Link cannot transport you on a relative or friend (including neighbours) we Ring-and-Ride we will endeavour to get you trans- can contact in an emergency. port with one of our volunteer driver’s in their own

Name: car. This costs 40p per mile from your driver’s starting point to your destination and return to the Home phone number: Here Cut driver’s starting point. Diamond travel card

Mobile Number: holders pay 30p per mile.

Travelling Companion Email: Are you lonely? Are you isolated? Do you need someone to travel with you and assist Please complete and return with your £15.00 We are here to help get you out and you? You may be eligible to have a companion registration fee, made payable to Four Towns & about. added to your Diamond Travel Card so that they Vale Link Community Transport. can travel free.

If you wish to pay by BACS. Please tick box We cover: Call: 01454 250500/510 Bank details: Lloyds Bank Sort code 30-16-11 Email: [email protected] Account No. 01179102  Almondsbury  Oldbury on Severn Reference: Members Full Name We will need BACS payment before transport  Alveston  Olveston Visit: www.4tvl.org.uk will be provided.  Aust  Patchway

Cut Here Signature  Bradley Stoke  Pilning Four Towns & Vale Link Community Transport, Date  Charfield  Severn Beach

 Cromhall  Rockhampton Would you like to receive our annual newsletter? Crossbow House, Yes No  Falfield  Stoke Gifford 58 School Road, Please provide email address:  Filton  Thornbury Frampton Cotterell, Bristol,  Frampton Cotterell  Tortworth For marketing purposes please tell us where you obtained BS36 2DA our registration form  Hallen  Tytherington

 Hill  Winterbourne Registered Charity No. 1084874 Office use only Company No. 3896636 2021 On system Called member Welcome Pack *However if you live close to any of the following areas we may still be able to help. Registration fee and travel costs will vary.

Services Opening Hours Registration Form

We aim to provide safe, cost effective, Monday to Friday 9am - 5pm Complete this form to register on our system and return to address overleaf: accessible transport to residents and groups in (Journeys outside of these hours may be possible the Four Towns & Vale Link areas to subject to driver and vehicle availability) Mr/Mrs/Miss/Ms other complement the existing transport system. Booking times 9.30am - 4pm Name: We offer a Ring-and-Ride service for individuals We require 48 hours advance notice before Address: and a Social Car Scheme with volunteers using travelling. However, for doctor/hospital their own cars. appointments, please book travel as soon as you

have your appointment. We currently have 21 mini buses, 16 of which accommodate wheelchairs and 3 Examples of Services: social cars.  Shopping trips Home Phone Number:

Cut Here  Social visits, special events Mobile Number: Ring and Ride  Work/education Email To qualify, residents must live within the Four  Hospital/doctor appointments Bus pass number Towns & Vale Link area (see over) and one of the following must apply: Please note we cannot always guarantee to get you

 By age qualification home after a health visit, always take your Dia- Bus pass expiry date ______mond bus pass and extra money for possible return  Have special needs Do you hold a bus pass plus (C for campanion) travel costs. Yes/No  Be in receipt of benefits Shopping Trips-Main days Wed, Thurs and Fri

 Have access problems Do you consider yourself disabled?  Morrisons + Asda, Cribbs Causeway Yes/No  Hold a Diamond bus pass  Sainsburys Filton, Asda Filton + Asda Patchway Do you use any of the following equipment Please leave 72 hours before booking for the  Tesco, Bradley Stoke to travel? (please tick) first time to enable registration to take place.  Tesco and Aldi, Thornbury Wheelchair Scooter

Cut Here Trips Requesting travel on Ring-and-Ride Shopping Trolley Guide Dog We also run trips to various places of interest. Registered service users can make travel requests by Trips are advertised on our website and in calling 01454 250500/510. Requests are made on a first Walking stick Zimmer Frame the local community. come first serve basis. Please be ready 15 minutes Escort Pushchair/Toddler before your pick up time.

New trip lists are available each month on our Wheelchairs and scooters need to have a risk assessment South Gloucestershire concessionary bus passes are website www.4tvl.org.uk or please send us a before travelling with us. If you have the manufacturer’s name accepted. Those with bus passes are entitled to travel and model name/number, this would be a great help to us. Stamped Addressed envelope. for £4 on local Ring-and-Ride journeys only. We will need to assess the occupant in the wheel-chair going Can you please advise us when you receive a new Bus in and out of our buses. There may be an additional fee for trips further Pass. To request a risk assessment please call the office afield. 01454 250500 Your details will be kept on our Four Towns & Vale Link Transport reserve the right to system and used for your travel bookings refuse, defer or cancel a registration. only, unless specified.