Specialized Service on NGtransit

Certain people are eligible for specialized service on NGtransit. This includes anyone who meets the definition of having a disability per the Accessibility for Ontario with Disabilities Act (AODA).

The information obtained in this application process will be used by the Municipality of North Grenville to assess the applicant’s eligibility for specialized transit service. The specialized service includes door-to-door service and the ability to ride with a support person. All information contained in the application will be kept confidential. The Municipality will provide the Operator a list of those eligible for specialized service and create an account for them in the booking system. The rider can then book a trip through the booking app, via the booking website, or by phone.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Do you have a disability as defined by AODA?

YesNo

Do you have a disability as defined by AODA?

YesNo

If yes, is the disability:

Unconditional: All trips require specialized service, for example a permanent disability.Temporary(up to one year): All trips require specialized services for a limited duration, for example during recovery from surgery.Conditional (May to September or October to April): Trips taken by a person with a disability who requires specialized services under certain circumstances, such as extreme weather conditions.

If yes, is the disability:

Unconditional All trips require specialized service, for example a permanent disability.Temporary(up to one year) – All trips require specialized services for a limited duration, for example during recovery from surgery.Conditional(May to September or October to April)–Trips taken by a person with a disability who requires specialized services under certain circumstances, such as extreme weather conditions.

Do you have reduced mobility?

YesNo

Do you use a wheelchair?

YesNo

Do you require a support person to ride with you?

YesNo

Do you require a support person to ride with you?

YesNo

Passenger Type

Date of Birth

Date

Would you like to receive your approval notification by:

EmailTelephone

Would you like to receive your approval notification by:

emailphone

Signature

By providing your signature you attest the information you have provided is accurate and complete to the best of your knowledge.

The information provided in this form is collected under the Municipal Freedom of Information and Protection of Privacy Act. Personal information on this form will be used to determine your eligibility for specialized transit services and to provide you with appropriate transit services. We may contact you to notify you of transit service changes. We will also use de-identified data to compile statistical information for program planning

Questions regarding the collection of this information and how it is used may be directed to 613-258-9569 ext. 0