Eccleshall Voluntary Car Scheme
www.eccleshallvoluntarycarscheme.org.uk updated on 3rd January 2019
“Eccleshall People helping Eccleshall People”
Eccleshall Voluntary Car Scheme
25 Wheelwright Drive, Eccleshall, Staffs, ST21 6LB
01785 851381 / 07815 419166
ECCLESHALL VOLUNTARY CAR SCHEME
Application to join the scheme as a voluntary driver
Full Name of applicant
Address (including postcode)
Date of birth
Home phone number
Mobile phone number
Drivers next of kin in case of emergencies
Make and model of vehicle
The DBS checking organisation (Ucheck) requires us to provide three forms of identity, passport number, driving licence number and a copy of a recent utility bill.
Driving Licence number
Driving Licence date of issue
Passport date of issue
Utility Bill A copy of a recent one to be supplied with this application form
Type of cover *
Date of renewal
*Fully Comprehensive cover is required
M.O.T number (if applicable)
Is your vehicle able to carry a fold up wheelchair? This would only be if the passenger has a carer with them YES / NO
A copy or sight of the vehicle insurance policy will need to be produced prior to you beginning to provide transport for our passengers together with a copy or sight of your current driving licence.
When you may be available
Drivers will all be able to offer a variety of days and times and types of service that they are willing or able to provide.
Once a month, once a week, occasionally.
Completing this form does not commit you to anything but gives the scheme an idea of how you can help.
Initially the scheme envisages providing weekday cover but it may occasionally require weekend cover, church visits for example.
Please mark the days of the week when you might be able to help with a yes and the days of the week when you have other commitments and would usually not be able to help with a no.
Monday Tuesday Wednesday Thursday Friday Sat Sun
Please mark all of the answers which apply to your possible availability
Weekly Monthly Occasionally
Daylight hours evenings
How often do you think you may be available to provide transport?
How far are you prepared to go?
Some drivers may be prepared to take passengers to Stoke Hospital, others may only wish to provided local journeys, to the doctors surgery, library etc. Some drivers may happy to accompany the passenger into the destination and wait with them, other would rather drop them off and wait outside. Some passengers may have carers with them who would accompany them. The short journeys may be just as important to travellers as the longer ones and they could easily improve their quality of life with a trip to the library for example.
What types of journeys would you consider?
Please mark the answer which best fits your possible availability
Doctors surgery Stafford Hospital Stoke Hospital
other medical visits
When booking transport, the passenger will be advised of the cost to them based on the mileage chart of fees. They will be told that any parking fees will be paid by them. The full fee that the passenger pays will cover your mileage fee and any residue helps to fund the various things that the scheme has to cover, insurance, D.B.S checks etc. Usually the driver will be expected to settle with the scheme treasurer any fees that they have collected during a set period (monthly) at the same time any additional amounts that are due to the driver will then be refunded.
The mileage you will be paid will include ‘light mileage’ without a passenger, from your home to the home of the passenger and return, this should be covered by the fee that the passenger pays.
The scheme is a voluntary project aimed at providing much needed transport to people in our community, you play a vital role in the whole scheme and we are grateful for your support.
If you know of anyone who might be prepared to join us as a driver or anyone who needs transport that might benefit from the scheme do please put us in touch.
The information contained in this form will only be used within the scheme itself and not passed to any third parties. By signing here you are agreeing to this being done.
Signature ………………………………………. Date ………………………….
Please return completed forms to Eccleshall Community Car Scheme, 25 Wheelwright Drive, Eccleshall, ST21 6LB.