Application for an on-street disabled people’s parking bay Passenger

• You must be a blue badge user.
• You must live at the address where you want the parking bay.
• You must have exceptional circumstances to have an on street disabled parking bay.

We will treat all information provided in confidence and in accordance with our privacy notice.

The fields marked with an asterisk (*) are required fields. All the information you enter will be submitted securely.

* Your name

* Your address

* Postcode

* Contact telephone/minicom number

* Email address

* Confirm Email address

Email addresses do not match.

* Blue badge number

* Vehicle make, model and registration number

* Please tell us what difficulties you have in trying to park your car outside your home

* How does not being able to park close to your home affect you?

* Is there a particular time of the day that you are unable to park close to your home?

If the driver leaves the disabled passenger to go and collect the car to park near their house, can the disabled passenger be left along in the house, or do they require constant supervision? If yes, please explain

If the disabled passenger’s driver is also a disabled person, please describe any other difficulties they may experience, for example, helping the passenger in and out of the vehicle, lifting a wheelchair in and out of the vehicle.

Please tell us if there are any additional difficulties experienced by the family, for example, the family has young children which mean the driver needs to transport both the disabled passenger and a very young child to the car.

Please tell us why it is important for you to be able to park outside your home, rather than being dropped off or picked up, even if this means double parking for a short while.

If this application is for a disabled passenger under 18, please give us their date of birth

Declaration

* I confirm that I am a blue badge holder and a passenger with exceptional circumstances and need to have a disabled people’s parking bay outside my home.

I Agree