Community bus application - 19 and 21 seater bus

Use this form to submit a booking for the 19 and 21 seat Community Bus.

1. Group details

Is this a booking for an Inner West Council activity?*

If yes, what account number should it be charged to?*

Is this group a non-profit and non-government organisation?*

If yes, please give details.

Is the group based in the Inner West Council area?*

Do the group's members predominantly live in the Inner West Council area?*

What is the purpose of the group?

Please describe how your group is transport disadvantaged.*

Please describe how your group meets the needs of elderly people, children, young people, people with a disability or disadvantaged residents.*

2. Booking details

Actvity name for which you are requesting use of the community bus.

Name of trip coordinator*

Phone number of trip coordinator*

Email address of trip coordinator*

2. Bus details

Which bus would you like to hire?*

3a. 21 Seat bus

Hiring time starts from the Balmain Depot (Llewellyn Street) - where a 30 minute bus safety check is undertaken prior to the bus trip. Hiring time finishes when the bus returns to the Balmain Depot.

How many people will be transported on the community bus?*

How would you like the bus configured for your activity? Please refer to the Community bus configuration options?*

Will your group require use of the bus hoist? (The hoist is suitable for people in a wheelchair or people who have difficulty climbing stairs)*

3b. 19 Seat bus

Hiring time starts from the Balmain Depot (Llewellyn Street) - where a 30 minute bus safety check is undertaken prior to the bus trip. Hiring time finishes when the bus returns to the Balmain Depot.

How many people will be transported on the community bus?*

Which type of hire are you applying for? (Please refer to the applicable fees and charges for each type of hire)*

For Dry Hire please complete a Dry Hire Application and submit with this form then continue to Section 4.

For Wet Hire please continue to Section 4.

4. Booking details

Please note: The minimum hire period is 3 hours.

Please list the specific date(s) and time(s) for your activities*

Pick up location*

Pick up time (am/pm)*

Destination for trip*

Drop off location*

Drop off time (am/pm)*

Date exclusions (i.e public holidays, school holidays)

5. Contact details

Organisaton or hirer's name*

Contact name*

Street address*

Suburb*

Post code*

Postal address (if different to street address)

Phone*

Email*

6. Invoicing details

Only complete if different to contact details.

Organisaton or hirer

Contact name

Street address

Suburb

Post code

Postal address (if different to street address)

Phone

Email

7. Particpants' details

Proportion of participants that live in the Inner West Council area*

Who is the activity primarily targeted at?*

Is the activity free to particpants?*

If you answered "No" to the above question, what is the cost per person per session?

Approximately what proportion of your participants hold low-income or pensioner Health Care Cards?*

Do you offer concessional/lower fees for people with a Health Care Card?*

8. Declaration

I have read and understand the Inner West Council - 19 and 21 Seat Bus Conditions of Hire and Community Bus Fees and Charges. I understand that information provided with this application (including the application form) and any subsequent information submitted as part of this application, may be disclosed under the provisions of the Government Information (Public Access) Act 2009 and correspondence from Council may be made available for viewing by the general public.**

9. Privacy statement

Application forms and/or names and addresses of people making an application is information that is publicly available. In accordance with section 18(1)(b) of the Privacy and Personal Information Protection Act 1998 (NSW), you are advised that all application forms received by Council will be placed on the appropriate Council file and may be disclosed to Councillors, Council officers, consultants to Council or members of the public. Pursuant to the provisions of the Government Information (Public Access) Act 2009, Council is obliged to allow inspection of its documents, including any application you make. However, should you wish for your contact details to be suppressed, please indicate such on the application form.

After you press submit a pop up box will appear stating that your form has been submitted successfully. If you do not see this pop up box please check the form to ensure you have completed all the mandatory fields, update any missing information and press submit again.