The Equipment Request form provides us with general information about the child who will be using the equipment, as well as contact information for the child's parent or guardian. The form should be signed by a parent or guardian at the time of equipment pick-up upon acknowledging that the loaned equipment is in good working order.Download
The Loan Agreement provides us with written verification that the terms of the equipment loan are understood, and that equipment will be reasonably cared for and returned to us when the child is finished using it.
The Liability Waiver at the bottom of this form must be signed by your child's therapist. If your child is not currently being treated by a licensed physical or occupational therapist, you must request that one of our volunteer therapists be present at pick up in order to insure that the equipment is properly fitted to your child. Equipment will not be released without a therapist's signature.
Picking Up Equipment
- Check equipment availability
- Schedule an appointment for pick-up
- Inform us if you will need the assistance of one of our licensed therapists
- Fill out & print the Equipment Request Form
- Fill out & print the Loan Agreement Form
- Have your child's therapist sign the liability waiver on the bottom of the Loan Agreement
- Bring your child with you to your equipment pick-up appointment if the equipment will need to be fitted by one of our volunteers
- Please consider our suggested, one-time contribution of $25.00 to help support our efforts