HomeMy WebLinkAboutMinibus RegistrationThe personal information collected on this form will be used by the County of Newell Minibus Service to ensure
the safety of all riders and provide appropriate assistance during transit as well as to contact riders regarding
route changes, service updates, or in the event of an emergency. This collection is authorized under section 4
(c) of the Protection of Privacy Act and Division 3 Public Utilities General of the Municipal Government Act. The
personal information collected will be protected by section 10 of the Protection of Privacy Act. Please direct any
questions about this collection to the Privacy Officer for the County of Newell at 403-362-3266 or
administration@newellmail.ca
MiniBus Registration Form
Name: ____________________________ ______________________________
Surname First Name
Municipal Address:
Mailing Address:
E-Mail Address:
Home Phone #:
Cell Phone #:
Emergency Contact: _____________________ _______________ ______________________
Name Phone# Relationship
Do you require assistance to and from vehicle? Yes ____ No____
Medical disorders and/or disabilities that we need to be aware of?
____________________________________________________________________
Do you use special equipment: Wheelchair, walker, cane etc.
Specify: _____________________________________________
Do you have any allergies? __________________________________________
________________________ ____________________________
Date Signature