Service User Registration Form

Eastern Bay Accessible Transport Charitable Trust

Purpose

This registration form is used solely for the purpose of collecting information necessary to:
• Register users of the Eastern Bay Accessible Transport Charitable Trust services; and
• Ensure service users have a safe, beneficial and pleasant experience.
You will only be asked to provide this information once when you register.

Service User Privacy

All information is obtained only for the purposes of registration for, and using, the community transport service. Personal details are protected and managed under the Privacy Act 2020, which rules how organisations, government departments and businesses can collect, store, use and share your information.

The Act ensures that:
• You know when and why your information is being collected;
• Your information is used and shared appropriately;
• Your information is kept safe and secure; and
• You can access the information an organisation holds about you.

Under the Privacy Act, you can ask for information that Eastern Bay Accessible Transport Charitable Trust hold about you, and to correct it if it’s wrong.

For more information

See Privacy' Commission - Your privacy rights


Registration Form

Fields marked * are required please


(Please select from the dropdown menu as you type - wherever possible)

(numerals only, starting with +64 or 0) (numerals only, starting with +64 or 0)


Female
Male
Non Binary
Prefer not to say
For example: 31  7  1972


European
Māori
NZ European
NZ – Other
Other / Prefer not to say

Pick-up Details

(Please leave blank if there are no issues with access)

No Yes

Relevant Health Conditions


(Our drivers offer door to door transport but cannot accompany to appointments or assist with shopping)
Sight  (S)
Hearing  (H)
Walking or steps  (W)
Memory  (M)
Communicating in own language (being understood or understanding others)  (C)
Any other health conditions we should know about   (O) (tick to open box to specify brief detail)

No Yes

(For passengers who cannot operate their own powered or non-powered wheelchairs, your carer/support person/family member can travel free with you)
No Yes

No Yes

Emergency Information

Click on 'Submit' above to send your registration. Thank you for participating in the registration process. Please contact our team to make a booking on 027 407 7526, or if your registered Personal information changes (do not send this form again)

Version 11   dated 3 September 2025