Kenilworth Community Transport Service registration form
  • Last updated:
  • 27 Sep 2021

Register now to become a passenger by completing the information below. Your application will be forwarded to the Kenilworth Community Transport Service Committee, who will be in contact with you to advise when your application has been processed. To submit this form you need to agree to your details being provided to The Kenilworth Community Transport Service which is supported by council, operated and administrated by the Kenilworth Community Transport Service sub-committee of the Kenilworth Chamber of Commerce.

Personal details
Given name/s
*
Surname
*
Mobile phone
*
Email
Street address
*
Please note that in order to become a registered user, you must reside in one of these localities.
*
Use of service
Health & Medical Services
Shopping
Access to the train
Social
Yes
No
We are committed to providing a transport service that is accessible for all Kenilworth residents. The service is not currently wheelchair accessible, however, the data collected here will inform future service improvements.
Declaration of registrant
*