Changing the lives of those we serve.

ADAPTIVE RECREATION FUND

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

Name of person with SB

First Name

Last Name

Date of birth

Birthday Shout Out

We are doing social media birthday announcements for our members with spina bifida that include a photo and brief bio (first name, age, city of residence, hobbies and interests, etc...). We will email you prior to the month of the birth date to collect this information.

Yes, please email me for a birthday shout out and I give SBWIS permission to use the photo and information I provide on social media to acknowledge this birthday.

No thank you.

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

Match and Meet

You are giving SBWIS permission to share your first name and email with other members to help you connect with peers.

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

Email blasts

Submit for Rec Fund

ADAPTIVE RECREATION FUND