AAW On-site or Events with Payment

AAW Reservation Request
For co-hosted events only:

Need to reserve an AAW Outdoor Wheelchair (OWC) at a co-hosted community event with one of AAW's Coalition Members?

Yes, great! Use this form and confirm that the Community Engagement Code (CEC) is filled in properly below.

Questions? Contact the event coordinator.

-OR-

For on-site today only:

Are you currently at one of our network partners, and you'd like to use one or more of our OWCs on-site today?

Yes, great! Use this form for a one-time reservation only. After your adventure, a completed client survey is required. This is a special reduced deposit for first-time users. Before your next outdoor adventure, become an AAW member (it's free!) and reserve your OWC in advance.
How did you hear about AAW?*
I am using the OWC*

at a co-hosted event; Community Engagement Code (CEC) required.on-site, today, at a hosting program location (Network Partner).
Enter the Community Engagement Code (CEC) here, starting with CEC- as shown.*
Location of OWC Use*
This is my first time using AAW equipment.

YesNo
Calendar Reservation Type

Community Event ReservationOn-site 1st Time ReservationOn-site Today Reservation

Emergency Contact

Prefilled with parent/guardian information. Click in each field to change if needed.
Emergency Contact First Name*
Emergency Contact Last Name*
Emergency Contact Phone *
Please enter a valid phone number.
Relationship to Client*
Example: Emergency Contact is the Client's _____

Confirmation
*Use this link for others to complete the AAW Use Agreement and Waiver and Release of Liability Form.
AAW Use Agreement and Waiver and Release of Liabilty (Link to text version)
Signature of Client*

Powered by Jotform SignClear
For minors, the parent/legal guardian must sign to confirm agreement with the terms above.
Signature of Parent/Legal Guardian*

Powered by Jotform SignClear
Parent/Legal Guardian First Name*
Parent/Legal Guardian Last Name*
Parent/Legal Guardian Email Address*
example@example.com

Date of Usage
First Available Event Date*

MonthDayYear
Last Available Event Date*

MonthDayYear
My Checkout Date*

MonthDayYear
Month in text

Submit and Pay via Paypal
Your Deposit Amount: On-site today (includes processing fees):

$62.75
Your First Time Only Deposit Amount: On-site today (includes processing fees):

$26.25
Your event deposit amount (includes processing fees):

$26.25
Enter Your Reservation Deposit Amount Shown Above*

prevnext( X )
USDDescription
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reservation ID #
AAW Authorization (internal use only)
Not for client use.
Location ID
Barron Res Email
example@example.com
Dane Res Email
example@example.com
Grant Res Email
example@example.com
Iowa Res Email
example@example.com
Milwaukee Res Email
example@example.com
Rock Res Email
example@example.com
Racine Res Email
example@example.com
Who - reservation form?
example@example.com
Barron CO/CI Email
example@example.com
Dane CO/CI Email
example@example.com
Grant CO/CI Email
example@example.com
Iowa CO/CI Email
example@example.com
Milwaukee CO/CI Email
example@example.com
Racine CO/CI Email
example@example.com
Rock CO/CI Email
example@example.com
Who - checkout/in?
example@example.com
AAW Team - this is a hidden field
Reply to email - this is a hidden field
example@example.com
Today's date

MonthDayYear
Date
Date to initiate Checkout Form

MonthDayYear
Date
AAW Admin email
example@example.com
On-site or Community Event for calendaring

On-site 1st Time Only ReservationOn-site Today ReservationCommunity Event Reservation
Loc for documents
AAW Surveys
AAW Reservations
AAW Checkout/in
AAW Reporting
AAW Events
Choose the appropriate reservation category:
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

AAW Reservation Request

Reservation Contact Information

Valid Photo ID Requirements

Emergency Contact

Confirmation

Date of Usage

Submit and Pay via Paypal