The Kids Equipment Network Application form
Measurements in Seating:
Due to the information we need to match a child to the equpment, we cannot do an application over the phone.
If you cannot access the online form, please leave your address at our phone number voice mail (listed below) and we will mail you the application.
Questions? Not enough space for all your information? Simple: Submit this information.
Then send an email with the child's name to firstname.lastname@example.org with any further instructions
You can reach us through the Community Physical Therapy Switchboard
at 630-766.0505 PRESS 8
Once we receive the form via online or mail, We will contact you within a week to discuss your needs
If you would like to download and fax or mail the application, please do so below: Fax: (630) 628.8176