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Request A Free Pediatric Belt Cane

Join a project and obtain a free standard pediatric belt cane

Photos of kids with Safe Toddles Belt Cane

We are dedicated to provide a free belt cane to as many children as possible. Free belt canes are available to children who become a valuable part of one of our research studies. All belt cane users given access to our curriculum. 

CONTACT INFORMATION

 

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PREFERRED METHOD OF CONTACT
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PHOTO / VIDEO RELEASE. CHECK ALL THAT APPLY

SHIPPING ADDRESS

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SHIPPING PREFERENCE

CHILD'S INFORMATION

CHILD'S MEASUREMENTS

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Does child receive any of the following services:
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If yes, where have the mobility devices been used?
Complete all fields to Submit the form, including uploading Consent Form for the study you have selected.

Thanks for your order!