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Home Transport Dial a ride Southampton Dial-a-Ride

Southampton Dial-a-Ride

Registration Form

If you would like to register to use Southampton Dial-a-Ride, please complete the below form.

    • Date Format: DD slash MM slash YYYY
  • The Dial-a-Ride service is specifically designed for use by people who are unable to use existing public transport. Please confirm below your reasons for being unable to use public transport.

  • My reason is:

  • reason
    • Other Disability
  • In emergency please contact:

  • SCA Transport is committed to ensuring equal opportunities for all prospective employees, current employees, volunteers, self employed contractors and customers. To ensure that we achieve this and do not discriminate, please give details of the following. All questions are optional; if you do not wish to give a particular piece of information please leave blank:

    • Ethnic Background (please tick one box):

    • White Other:
    • Mixed Other:
    • Asian or Asian British Other:
    • Black or Black British Other:
    • Chinese or other ethnic group Other:
    • Nationality (please tick one box):

    • Nationality Other:
    • Gender (please tick one box):

    • Religion or Belief:

    • State Religion:
    • Disability:

    • If yes, please tick relevant box below:

      Type of Disability:
    • Marital Status:

  • I give my consent that any information given may be stored as computerised or manual data. This data may be used for the purposes of monitoring the makeup of our customer base and may be seen by senior managers or officers of the company involved in the monitoring of such data.

    • Date Format: DD slash MM slash YYYY
    • By completing this form you confirm that you are not able to use existing public transport due to a disability (please note that in some circumstances we may request a signed letter from your doctor to confirm your eligibility for the Dial a Ride service).

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SCIA Group, Amplevine House, Dukes Road, Southampton, SO14 0ST. Charity Registration No. 1096903

Social Care in Action (SCA Group): registered as a company limited by guarantee no. 04526806, charity registration no. 1096903 - Registered with Companies House (Cardiff) and Charity Commission

SCA Care, registered with charitable status under the Co-operative and Community Benefit Societies Act 2014, no. 27461R - registered with the FCA (London)

SCA Transport Services, registered with charitable status under the Co-operative and Community Benefit Societies Act 2014, no. 29035R - registered with the FCA (London)

SCA Trafalgar Dental Services, registered with charitable status under the Co-operative and Community Benefit Societies Act 2014, no. 29975R - registered with the FCA (London)

SCA Fenwick2, registered with charitable status under Co-operative and Community Benefit Societies Act 2014, no. 30336R - registered with the FCA (London)

Options Wellbeing Trust: registered as a company limited by guarantee no. 4699108, charity registration no. 1100782, British Association of Counselling & Psychotherapy registration no 101217 - Registered with Companies House (Cardiff), Charity Commission.

Southampton Healthy Living - registered as a company limited by guarantee no. 10627689 - Registered with Companies House (Cardiff).

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