Enw llawn / Full Name (required):

Enw’r gofalwr - teithiwr ychwanegol cyntaf / Carer's Name - first additional passenger (required):

Enwau teithwyr ychwanegol / Names of additional passengers:

Cyfeiriad / Address:

Cyfeiriad e-bost / Your Email (required):

Rhif ffôn symudol / Mobile (required):

Enw cyswllt brys / Emergency Contact Name (required):

Rhif cyswllt brys / Emergency Contact number (required):

Y rheswm dros fynd ar y ‘Trên Nerth’ / Reason for going on the Rainbow Train (required):

Rhowch unrhyw wybodaeth feddygol ychwanegol rydych yn awyddus i’w datgelu / Please provide any additional medical information you wish to disclose. (required):

Ydych chi’n defnyddio cadair olwyn / Do you require wheelchair access (required):
YESNO

Sylwch mai dim ond hyn a hyn o leoedd sydd ar gael ar y Trên Nerth / Enfys. Sylwch y gallai fod angen cyfyngu ar nifer y teithwyr fesul teulu er mwyn caniatáu i gynifer o bobl â phosibl elwa ar y ‘diwrnod arbennig’.

Please note that spaces on the Rainbow are limited. The number of passengers per family may need to be restricted to enable as many people to benefit from the ‘day with a difference’ as possible.