Wandsworth Borough Council

Children’s Services Department

Parent/Carer application for home to school travel assistance for a child or young person with a Statement of Special Educational Needs (SEN)

Please complete the sections as fully as possible

Child/Young Person’s Name:

/

Date of Birth:

Year Group:

Looked After Child (by Social Care) Yes/No

If yes, name of Social Worker:

Parent/Carer(s) Names:

Home Address:

Home Telephone:

/

Work Telephone:

/

Mobile Telephone:

Email address:

Child’s Home Address (if different from above)

School Name and Address:
Times and days your child attends or will be attending school:
Please give details of your child’s special educational needs (SEN) and why you are seeking assistance with travel from the Local Authority:
Can you or another parent/carer accompany your child to school on public transport? If not please give reasons why (if your child has more than one significant parent/carer please give details why each person cannot provide travel assistance)
Do you have a car? If you do can you or another parent/carer drive your child to school? If not please give reasons why.
(if your child has more than one significant parent/carer please give details why each person cannot provide travel assistance)
Can your child walk to school independently? Yes/No
If no, please explain why this is not possible, including the approximate walking distance from home to school:
Can your child travel to school by public transport independently? Yes/No
If no, please explain why this is not possible, including details of the journey required by public transport:
If your child is not able to travel independently, can you accompany or transport your child to school? Yes/No
If no, please explain in detail the reasons why:
Please state if you are able to do one of the school runs. For example can you drop your child off in the morning but not pick them up in the afternoon?
How is your child currently getting to and from school?
Do you have a disability? Yes/No
If yes, please explain how this affects your ability to travel with your child to and from school:
Do you have other children attending school? Yes/No
If yes, please give their names and ages and the schools they attend and how they travel to school:
Transport will normally be offered in the form of reimbursement for fares/mileage or a travel budget and alternative means of transport will only be provided in more exceptional circumstances. If travel assistance in the form of fares/mileage reimbursement or a travel budget was agreed would you able to transport your child to school? Yes/No
If no, please explain why this would not be possible:
If transport in the form of a taxi were considered, would you be able to act as your child’s escort if this was required? Yes/No
If no, please give reasons:

Special Requirements

Does your child use a wheelchair? Yes/No
If yes, please complete additional sheet below
Does your child need other special seating provision? Yes/No
If yes, please give special seating requirements needed and complete additional sheet below
Is your child able to walk to and from the relevant vehicle on his/her own Yes/No
If no, please give reasons
Does your child have significant emotional / behaviour difficulties that could pose a risk? Yes/No
If yes, please give reasons
Does your child have any significant medical needs en route e.g. requires oxygen? Yes/No
If Yes, please provide details:

Additional Information

Please use this space if you feel that you have further relevant information that you wish to add:

Declaration

I declare that to the best of my knowledge the information I havegiven is correct and complete. I will inform the LA if any details I havegiven change and which might affect any agreement made to provide transport assistance to my child.
Signature: Date:

For queries on this form please ring 020 8871 8061. Please return the completed application form to the following address:

Special Needs Assessment Section

Wandsworth Council

4th Floor Town Hall Extension

Wandsworth High Street

SW18 2PU

For wheelchair users:

To help with obtaining the safest mode of transport for your child when travelling in their wheelchair, please supply the information requested below:

Please indicate type of wheelchair used i.e. Electric/manual/collapsible/other
What it the make of the wheelchair?
Does the wheelchair have a headrest? Yes/No
Has it been approved for travel in a vehicle with a child occupant? Yes/No/Don’t know
Has it been crash-tested? Yes/No/Don’t know
Please provide information on anchorage points and tie-down systems, if available
Please attach manufacturer’s instructions for safe transport, if available
Please provide any other information that you think we should know