Register online
to use Ring and Ride

If you feel that you (or a friend or relative) could benefit from using Ring and Ride, please complete the form below to become a registered user of the service. You can register on behalf of someone too.

Please note that our Ring and Ride service is for residents of the West Midlands only. Other similar schemes exist throughout the UK.
 

1. Your details

Title:

First name:

Surname:

Address:

District:

Telephone:

Mobile:

E-mail:

Date of birth:

2. Please provide details of an emergency contact

Name:

Relationship:

Address:

Telephone:

3. What are the problems you have in using ordinary bus services?

I cannot get to a bus stop

I cannot get on a bus

I cannot travel on a bus

4. Which of the following best describes the reason for this?

I cannot travel without a companion or carer

I have limited mobility

The journey takes too long

I don't understand how buses operate

Fear (anxiety)

Poor street design (eg. no dropped kerbs)

5. What is/are the condition(s) you have that causes the above problems?

6. If you use a mobility aid to help you get around, please tick the appropriate box(es):

I use a manual wheelchair and can transfer

I use a manual wheelchair and cannot transfer

I use a powered wheelchair and can transfer

I use a powered wheelchair and cannot transfer

I use a scooter

I use a stick(s) / crutch(es)

I use a walking frame

I have a guide / helping dog

I will need to use the passenger lift

Other (please explain)

7. Do you have any other requirements we need to know about?

8. Please tick your ethnic origin:

White British

White Irish

Any other white background

White and Black (Caribbean)

White and Black (African)

White and Asian

Any other mixed background

Indian

Pakistani

Bangladeshi

Any other Asian background

Caribbean

African

Any other Black background

Chinese

Any other Chinese background

Other ethnic group

9. Passenger declaration

I confirm that the above details are correct and that I need to use Ring and Ride because I find it either impossible or difficult to use other forms of public transport.

I will inform Ring and Ride if there are any change in my circumstances that affects my eligibility to use the service.

10. Data protection

Certain details on this form will be stored on a computer for administrative and statistical purposes. All personal data will be held in accordance with the provision of the Data Protection Act. We will NOT release any personal information without the authorisation of the service users.