Request: Changing Places key

Mandatory field

Use this form to apply for a Changing places key

Name of carer

I have been trained in the use of equipment inside the Changing Place facility and I have read and understood the guidance.

Agree

Carer's address

Carer's email address

Carer's email address (Confirm)

Name of user

User's address (if different to carer's)

Does the user give consent for their benefit information to be held by Chelmsford City Council?

DLA evidence (Changing Places are only available to people receiving the higher rate Disability Living Allowance. If you can't upload the evidence now, please send by post quoting your form reference number)

Which address should the Changing Place Key be sent to?

Carer's address
User's address

Date submitted

Click 'Next' where appropriate to progress through the form. When you get to the end, you only need to press the submit button once.

Data protection declaration: We are a Data Controller for the purposes of data protection legislation. We hold and process all personal information in accordance with data protection legislation. For more information, you can read our privacy policy and privacy notices

Also in this section

Contact the Public Toilets Team

01245 606606

Mandatory field

Is there something wrong with this page

First name

Last name

Address

Email Address

Email Address (Confirm)

Phone number

Problem

Date

Go to:

You are here »»»»»