Stratford Parallel Transit Application

Steps to Complete Passenger Application

Stratford Parallel Transit is a shared ride service for individuals who are unable to access Stratford Transit, using well-trained, caring drivers and lift-equipped buses that provide accessible door to accessible door service. This service can be used for medical appointments, therapy, education, employment, shopping and social activities.

Am I Eligible?

Parallel Transit is for persons who are:

Physically unable to use Stratford Transit
Physically unable to walk a distance of 175 metres (575 feet)
Have temporary mobility impairment (i.e. a broken leg)
Physically unable to walk 175 metres (575 feet) during winter months

How to Apply

STEP 1 – Download the Healthcare Form at www.stratford.ca/paralleltransit to take to your Healthcare Professional and return a completed printed copy with your completed printed Passenger Application (Step 2).

This form must accompany all Passenger Applications (see Step 2), whether submitted online or delivered to our offices in a printed format.

STEP 2 – Complete Passenger Application, either online or in a printed format by the person applying to use the service, or their designate.

Choose one method:

Online – Complete and submit the application online at www.stratford.ca/paralleltransit
Print – Download this form, or obtain a copy from the Parallel Transit Office or a Parallel Transit Driver. Once completed, submit your printed application (along with your completed Healthcare Form) to a Driver, fax at 519-271-6029, mail or drop off at 60 Corcoran Street, Stratford, Ontario N6A 1V7.

Frequently Asked Questions

Applications must include both a completed Healthcare Form and Passenger Application.
For assistance completing either form, please call 519-271-4000, Monday to Friday 9am - 5pm.
Parallel Transit reserves the right to re-evaluate passenger applications and request a reassessment.
Parallel Transit is not responsible for any cost associated with the completion of forms and applications.
In the event an application is denied, a third-party assessment may be obtained with all costs being incurred by the applicant.

Section A: Applicant Information

Healthcare Form

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Applicant, First Name

Applicant, Last Name

Email Address

Address

City

Postal Code (format XXX XXX)

Telephone

Alternate Telephone

TTY Telephone #

Date of Birth

Emergency Contact, First Name

Emergency Contact, Last Name

Emergency Contact, Address

Emergency Contact, City

Emergency Contact, Postal Code (format XXX XXX)

Emergency Contact, Phone Number

Emergency Contact, Alternate Phone Number

If you are not the applicant, but have completed this form on the applicant's behalf, please provide the following information:

Your Name

Your Address

Email Address

Your City

Your Postal Code (format XXX XXX)

Your Phone Number

Your Relationship to Applicant

Section B: Parallel Transit Eligibility

Is the applicant a minor?

Yes

No

Can the applicant access Stratford Transit?

Yes

No

Can the applicant walk 175 metres (575 feet)?

Yes

No

If it is difficult to use Stratford Transit, please explain why:

Can the applicant travel on their own without an assistant or aide?

Yes

No

If no, please give a brief explanation:

Please indicate if any of the following items pertains to the applicant:

Is affected by a temporary disability? (i.e. broken leg)

Yes

No

Is using portable oxygen?

Yes

No

Is using a cane?

Yes

No

Is using crutches?

Yes

No

Is using a walker?

Yes

No

If using a walker, what kind of a walker is it?

Non Folding

Folding

Is using a scooter? (Must be able to transfer independently to a seat on the bus.)

Yes

No

Is using a manual wheelchair?

Yes

No

Is using a power wheelchair?

Yes

No

Is using an oversized wheelchair (greater than 31" wide)?

Yes

No

If greater than 31" from outside to outside wheel, please indicate all of the dimensions.

If the applicant uses a mobility aide, is the residence accessible?

Yes

No

Is legally blind? (Uses a service dog or white cane)

Yes

No

Applicant Signature/Designate Signature: I certify that to the best of my knowledge the above information is correct.

Clear

Notice of Collection

Personal information collected on these forms is collected under the authority of the Municipal Act, 2001 and will be used by the City of Stratford staff for the purpose of determining eligibility for Parallel Transit Services. Questions regarding the collection of this information may be directed to the City Clerk, P.O. Box 818, Stratford, ON, N5A 6W1 or by telephone 519-271-0250 extension 235 during business hours.

If you require this form in an alternate format, contact Community Services at 519-271-0250 extension 264 or TTY at 519-271-5241.