Fundy Region Community Transportation
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Name *
First and last name
Address *
Email *
Phone number *
Date of Birth *
How did you hear about us?
What class is your Drivers License? *
Do you have a minimum of 2 million liability insurance? *
Are you willing to pick up multiple clients if they are headed in the same direction? (i.e Kidney Dialysis patients going to the someplace for same time) *
Are you willing to accept the title "Awesome Human Being"? *
What is your availability? *
What is the Make, Model & Year of your vehicle(s) *
Are you comfortable providing assistance to people with physical disabilities if necessary? *
Some clients may require extra help or need you to stay with them during their outing. Are you willing/able to assist in this regard when necessary? *
Are you willing to provide a criminal record background check by your local Police/RCMP, a background check with Social Development and a Drivers Abstract check? *
Are willing to sign an "Oath of Confidentiality' stating your intent to keep confidential any information you are made privy to regarding our clients? *
Is there any additional information that we should be aware of that may affect your ability to volunteer as a community driver?
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