Forms home Home to School Travel Assistance Form Please read the privacy statement to know about how we will use your information Privacy Policy Use this form to apply for assistance with travel to and from school. This is for students with special educational needs, disabilities or on medical grounds. If you require help with completing this form, please contact SEN & Inclusion Transport Section on 0208 708 8214/5 or by e-mailing sen.transport@redbridge.gov.uk nnPlease note: We normally require 4 weeks to process a transport application. The Special Educational Needs & Inclusion Services will decide what form of transport assistance will be provided.n Step 1 of 5 20% Details of ChildName: First Last Middle name:Known as (if different from forename):GenderMaleFemaleCurrent AddressFind addressSelected address Enter your postcode in Redbrige to select your addressCurrent Address Street Address Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Date of birth: Date Format: DD slash MM slash YYYY Current SchoolSchool that you require transport to:Name of SchoolAddress of SchoolPostcode:Date which you require transport to commence: Date Format: DD dash MM dash YYYY Days transport required Monday am Tuesday am Wednesday am Thursday am Friday am Monday pm Tuesday pm Wednesday pm Thursday pm Friday pm Does your child have a Statement of Special Educational Needs?(Required)YesNo Details of Parent/Carer (please inform this office by sending an email to this address <insert email here> if any of the information changes, after submission)Title:MrMrsMsMissRev.Fr.Dr.ProfHonSirLordLadyName: First Last Address (if same as child leave blank)Find addressSelected address Enter your postcode in Redbrige to select your addressAddress Street Address Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Contact Details:Home:Work:Mobile:(Required)A mobile number must be provided as transport updates are sent by text message.Do you want a copy of this application details to be sent to you?(Required)YesNoEmail:(Required) Enter Email Confirm Email Email: Emergency Contact details:Name: First Last Relationship to child:Contact number: Additional Information(Required)Please explain why you think your child needs transport to and from school and why you cannot make your own arrangements to provide this assistance. To help with the transport decision, please only include information relating to your child’s needs ie why your child is unable to access public transport or travel with a parent in their own vehicle. Please read the entire form prior to completing this information box to avoid duplication of information, as some of the detail maybe asked for in another part of this form. *Please not any transport assistance provided is at the Special Educational Needs and Inclusion Services discretion and is annually reviewd Are you in receipt of higher rate mobility component (HRMC) of the Disability Living Allowance(DLA) for your child?(Required)YesNoThis will not affect your statutory entitlement, but will help the decision makers to make a more informed decision for an appropriate form of travel assistance.Your Child's Personal DetailsPlease answer the questions below to assist us with transporting your child safely & comfortably.Does your child travel in a Wheelchair (which must be crash tested)?(Required)YesNoIs your child able to walk to and from the vehicle?(Required)YesNoDoes your child need a car seat?(Required)YesNoDoes your child need a booster seat?(Required)YesNoDoes your child require lifting on & off the seat?(Required)YesNoIf the answer is yes, parent/carer will be asked to assist their child on and off the vehicle seat.Is your child able to fasten & unfasten their own seatbelt?(Required)YesNo Your Child's Needs, Language & CommunicationDoes your child have hearing difficulties?(Required)YesNoDoes your child have visual difficulties?(Required)YesNoHow does your child communicate, i.e. verbally (if so, what language), signing, Makaton etcDoes your child have emotional and behaviour difficulties?(Required)YesNoPlease explain how these are displayedPlease describe if your child have any fears that could effect him/her on transport i.e. loud noises, colours, smells, items of clothes, crowds etcIf your child becomes anxious or distressed, what behaviour is displayed and how do you calm him/her?Does your child have physical or sensory difficulties?(Required)YesNoPlease give an explanation on how your child display this.Medical InformationDoes your child have epilepsy?(Required)YesNoPlease describe his/her fits - when they may occur, for how long & what action to take (please provide a copy of any medical care plan or protocol that you have)Does your child have any other Medical needs that may affect transport, not previously mentioned e.g. requires oxygen?(Required)YesNoif you selected yes to either of these questions, please can you supply more information, for example, any potential triggers, symptoms, duration of seizure medical/health protocol or any additional information that may assist with safer travel(Required) Independent Travel Training (ITT)SEN & Inclusion section is currently running an Independent Travel Training Program. It is intended that learners should be able to leave the scheme with the ability to travel independently. (Please note that an assessment takes place within the home with the pupil and parent(s) prior to a pupil commencing this program.) Please tick this box if you're interested in this scheme Yes, I am interested in this scheme Receiving transport newsPlease tick the box if you would be interested in receiving transport updates (i.e. delayed transport, weather warning etc.) from the following :Receiving transport news Twitter Facebook Home to School Transport website Others (please specify Please specifyDeclarationDeclaration(Required) I declare that to my best of my knowledge the information I have given is correct and complete, I will inform the Special Educational Needs & Inclusion Services if any details I have given change. I agree that if transport assistances is agreed, the information I have given may be shared with Redbridge Transport Services to provide my child with safe and appropriate transport. It can take up to 4 weeks to process an application form
