Equipment Application

Please note: Applications will reopen on February 1, 2021 with a NEW application form. Old forms will no longer be accepted.

Please be patient as we process applications and CLICK HERE look at our Frequently Asked Question (FAQ) page to find additional information.

Easter Seals Alberta has knowledgeable and friendly staff ready to assist you with your application.

If you are applying for power mobility equipment or a hospital bed, you will submit the Client Equipment Funding Request Form, Occupational or Physiotherapist Assessment, and Medical Report Form. For all other equipment requests, you will submit the Client Equipment Funding Request Form ONLY.

If you would like to return a piece of equipment that has been loaned to you by Easter Seals Alberta, please fill out the Pick Up Equipment Request Form. If you would like to make an equipment donation, please fill out the Donate Used Equipment Form.

Please fill out the necessary forms below and submit them using the “Submit Completed Form” button, email them to us at accessibilitysupports@easterseals.ab.ca, or mail them to us at 103, 811 Manning Road NE Calgary AB T2E 7L4. 

Application Forms

Please Note

  • Easter Seals Alberta provides equipment to children, youth, adults, seniors and families with any disability.
  • Easter Seals provides the following mobility equipment when all other funding source options have been exhausted: hospital beds, lift assist chairs, porch lifts, stair lifts, mobility scooters, power wheelchairs, portable ramps and ceiling tracks.
  • Applicants must include their household Income Tax Notice of Assessment from two years prior.
  • Wait times can vary as this program experiences a high level of demand.
  • Information provided is confidential and used only for the purpose it was intended.

Give A Kid A Lift Application

Pick Up Equipment Request Form

Donate Used Equipment Form

Medical Report Form

Occupational Therapist Assessment Form

Equipment Application