Membership form - Morecambe Bay Partnership

This Mobility Vehicle Membership MUST be in the name of the person who is going to use the mobility vehicle.

Please take time to read the Mobility Vehicle Membership Terms and Conditions before you proceed.

To ensure that our mobility vehicle scheme is suitable for you before you set out on your Morecambe Bay adventure, please read following statements and tick all the statements that apply to you.

These statements will form a part of the Terms and Conditions of your Morecambe Bay Mobility Vehicle Membership.

Mobility Vehicle Membership Form

Name (must be that of person who will be using the vehicle)

First Name *

Last Name

I confirm the above name is the person who will be using the mobility vehicle

Contact Details

Address 1 *

Address 2

City

ZIP / Postal Code

Email *

Phone *

Declarations

I weigh no more than 159kg/ 25stones

I can read a vehicle number plate from a distance of 6 meters and have no significant visual impairment that would prevent me from reading safety signs, avoiding obstacles or other hazards.

I wish to hire a Tramper; I have enough upper body strength, upper limb mobility and hand dexterity to grip both Tramper handlebar grips securely and operate the twist grip.

I wish to hire a mobility scooter; I have enough upper body strength, upper limb mobility and hand dexterity to grip both mobility scooter handlebar grips securely and operate the squeeze grip.

I have sufficient learning abilities to understand information presented by the instructor, be able to operate and safely control the mobility vehicle, identify and avoid hazards and to react to changes in the surrounding environment.

I am 18 years old or over, or I am 14-17 years old and will be accompanied always by a parent, guardian or carer (you will be asked to name this person on your booking form).

I confirm that I have read and agree to the Mobility Vehicle Membership Terms and Conditions (see link above).

Medical Declaration

I will consult my doctor before using a mobility vehicle if:

- I have a medical condition that causes / could cause seizures or convulsions; or that affects / could affect my memory, level of consciousness or alertness, balance, mood, or anxiety levels

- I have a history of back problems or spinal conditions.

I accept that registration can only proceed if all the boxes are ticked to confirm that the statements apply and that if I cannot confirm each of these statements, the mobility vehicle hire scheme may not be suitable for me.

Feel free to contact us to discuss why this may be.

I must inform you if there are any changes to my medical circumstances as detailed above before hiring and/or using a mobility vehicle.

Please give any other medical information which is relevant to the use and hire of a mobility vehicle

Please give details of any other similar schemes of which you are a member

Membership Type

Membership type *

Mobility Vehicle Membership Form

Mobility Vehicle Membership Form

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