Registration | Community Driven

Registration Form

Please select the registration form below and ensure that all fields are completed and then click submit.

"*" indicates required fields

What are you registering for?*

I'm registering as a passenger

I'm registering as a passenger companion

Name*

First Last

Date of Birth*

Mobile Phone*

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have Ambulance cover?**

Yes

Emergency Contact*

First Last

Emergency Contact Phone Number*

Please list any specific requirements or medical needs you may have, eg. mobility support

I believe/my doctor has informed me that my medications and medical condition do not affect my ability to manage my own medical care during transport.

I understand that the driver is providing a Volunteer Transport Service only and any conduct which may be detrimental to the interests of Community Driven may result in my exclusion from future use of this Service.

Romsey and Lancefield Neighbourhood Houses and their Volunteers are not liable for any injury, loss or damage (whether direct or consequential) arising from my participation in the Project.

I declare that to the best of my knowledge all information provided in this registration is true and correct.

I have read and understood the Community Driven Participant Requirements and agree to adhere to these.

I undertake that, I will comply with all relevant state road laws for passengers whist accompanying a driver in the Community Driven program.

I have read and understand the requirements of this position as outlined in the Community Driven Participant Requirements document and agree to abide by them.

I understand that any false or misleading information given in this application may result in my participation of the Community Driven program to be terminated.

I agree to uphold the privacy of other participants in the Community Driven program and maintain confidentiality after my participation of the Community Driven Program ceases.

I declare that to the best of my knowledge all information provided for or in relation to the Community Driven program registration is true and correct. I also understand the content and nature of this agreement.

Declaration*

Yes, I agree with the above declaration

Date*

Children under the age of 16years are required to be accompanied by a parent / guardian at all times.
Approved Child Seats may be used in the Community Car. These are required to be fitted and removed by the parent.

I, undertake that, I will comply with all relevant state road laws for passenger’s whist accompanying a driver in the Community Transport Program.

I have read and understand the Community Driven Participant Requirements and agree to abide by them.

I understand that any false or misleading information given in this application, whether in writing or verbally, may be reason for my participation in the Program to be terminated.

I agree to uphold the privacy of other participants in the Community Transport Program and maintain confidentiality thereafter. I declare that to the best of my knowledge all information provided in or in relation program registration is true, complete and correct. I also understand the content and nature of this agreement.

Driver Declaration*

Yes, I agree with the above declaration

Date*

This field is for validation purposes and should be left unchanged.

If you’d prefer to download and print the registration form, please click on the relevant button below.

Passenger Registration

Passenger Companion Registration

Passenger Registration Terms, Conditions and Requirements

The purpose of this document is to inform all participants of the Community Driven project (CD) of their requirements and responsibilities. All participants of CD are encouraged to read and understand all relevant legislation, policies, procedures and eligibility.

Eligibility

All participants of CD must complete the relevant registration form for their proposed participation.

To be eligible for involvement with CD participants must be:

A resident of the Lancefield-Romsey district
Passengers must over the age of 16 unless accompanied by a parent, carer or guardian.
Volunteer drivers must be over the age of 18

Passengers (including driver and passenger companions):

Passengers must be able to self-manage existing medical conditions.
Passengers must disclose if they are being administered a general anesthetic. An extra support person may be required for transport. Eligibility will be under advice from the medical practice.
Passengers are encouraged to carry a mobile phone during trips so they can be contacted by the driver or Community Driven administration.

Drivers:

Drivers are required to hold, and carry with them, an Australian drivers license without restrictions that may prohibit their involvement with the program.
Drivers must drive in a lawful and safe manner, complying with all state road laws and regulations.
Drivers must carry a mobile phone during all travel with their contact number available to the Community Driven coordinator and the passenger.
The car a driver intends to use for transportation must be road worthy and registered The car has to be registered and approved by the Community Driven program coordinator.
Drivers must hold a current police check and working with children check.

Ineligibility

Access to the Community Driven program may be suspended or terminated at the discretion of the Coordinator. For example, participation may be suspended or terminated in the case of;

false or misleading information being provided in relation to registration for the program
misuse or abuse of the services provided
any breaches of the Community Driven program requirements and eligibility
a person using this service is intoxicated, is under the influence drugs or fails to disclose relevant medical information.

If a participant’s registration is suspended or terminated, the participant will be informed via the best means possible with an explanation for the decision to suspend or terminate the participant’s registration.

Reimbursements

In order to maintain a fair and sustainable service the Community Driven program asks passengers to make a donation for the service provided. The suggested amounts can be found on the current Community Driven booking form.

Volunteer drivers of the program will be reimbursed a scaled rate for fuel costs. The process for claiming driver reimbursement of expenditures such as tolls, parking and meals will be explained to drivers as part of the induction training.

Legislation

The Community Driven program is guided by certain legislations. These include;

– Occupational Health and Safety Act 2004

All participants are responsible for ensuring the safety of themselves and others, taking appropriate measures to minimise the risk of injury or harm and reporting any incidents, accidents or potential hazards.

–Equal Opportunity Act 2010

All participants of the Community Driven program are required to respect the rights and diversity of other participants and are encouraged to report any cases of discrimination or harassment to administration.

–Privacy and Data Protection Act 2014

All participants of the Community Driven program are required to adhere to policy in regard to the collection, sharing and storage of personal information.

-Road Safety Act 1986

-Road Safety (Driver) Regulations 2019

It is the responsibility of all drivers to ensure adherence to all current state road laws and regulations.

All passengers are encouraged to respect the driver’s wishes and preferences when travelling to ensure safe driving practices and driver comfort. It is the responsibility of the care giver or guardian to fit the appropriate restraints on a person who is unable to do so for themselves.

Polices

The Community Driven program is guided by certain Romsey Neighbourhood House policies and procedures

These include;

-Privacy

The Community Driven program is committed to maintaining the privacy and confidentiality of all participants. All personal information collected will be done in accordance to the Romsey Neighbourhood House Privacy Policy. Participants are encouraged to respect the privacy of fellow participants who may disclose information regarding their personal life or health matters.

–Grievance

All participants of the Community Driven program have the right to report any concerns they may have and receive assistance to achieve a fair resolution to address any matters that may arise. All complaints will be addressed in accordance to the Romsey Neighbourhood House grievance policy.