ADAPTIVE RECREATION FUND

Please complete this form and click submit. Our staff will process your request and send you a check within 2 weeks.

Parent testimonial from Jenny:

“My eyes are filled with tears and my heart overwhelmed with love. Thank you from the bottom of hearts. Without this funding, we would not be able to financially send Gavin to this program. We both work full time and do our absolute best to provide as many life experiences as possible to our four kids. We want them to change the world one day at a time. We are extremely blessed to have found the Spina Bifida of Wisconsin and appreciate the help given to us for Gavin as we do not qualify for any other support. Thank you!”

Name of person with SB

First Name

Last Name

Date of birth

Name of person completing this request

Parent / Legal Guardian

First Name

Last Name

Email of person completing this form

Home mailing address of person completing this form

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Wisconsin County you reside in

Adaptive Recreation program or equipment need

Provide a brief description of what you'll use this money towards (must relate to needs of person with spina bifida)

Please share your suggestion(s) for additional ways SBWIS might support your family member with spina bifida

We recognize your concern that receiving this gift could impact monthly benefits from SSI. We can make a check out to an organization for direct payment. Who should we make the check out to?

Checks will be mailed to you for proper submission to the organization.

How do you keep in touch with SBWIS?

Checking the website

Following Facebook posts

Newsletter postcard

Submit for Rec Fund

ADAPTIVE RECREATION FUND

Parent testimonial from Jenny: