Permanent Access Code Registration Form - Changing Places Adult Change Facility

Applicant

Name

Mobile Number

Address

Status

The Access Code is restricted to people who have a disability.

The Access Code is not transferable and is only to be used by the person to whom it has been issued.

Mobility Parking Permit

Disability Card or similar

Letter from your Doctor

Letter from a Disability Organisation

Declarations

I declare I am entitled to an Access Code

All information give is true and correct