AAW Reservation Request-Additional Information

AAW Reservation Request: Additional Information
Please complete the required fields to complete your request. AAW will confirm your reservation request if equipment is availabe for the selected date(s).

Note: some fields are prefilled from your order and cannot be changed.
How did you hear about AAW?*
Planned activities / adventure with AAW's outdoor wheelchair(s)*
Briefly describe the planned activities or adventures you (client) hope to participate in with AAW's outdoor wheelchair(s).
Choose the appropriate reservation category:*
Checkout Location*

Da1) AAW - Madison Metro (Cross Plains/Oregon Area/North Bristol)Ba2) Barron County (Rice Lake - Blue Hills SC)Gr1) Grant Co. (Mt. Hope - Stagman Shed)Io1) Iowa Co. (AAW Main Office)Mi2) Milwaukee County (Franklin - Wehr Nature Center)Ro1) Rock Co. (Evansville - Halfmoon Outdoors)Other:
Type of Reservation
Prefilled from your reservation request
OWC/Trailer Requested
OWC# Reserved
Prefilled from your reservation request
Trailer# Reserved
Prefilled from your reservation request

Dates & Length of Time for Reservation Request

At this time we may reserve the chair longer than 7 days at a time if there is no waiting list.

Please specify your preferred checkout and checkin dates and timeframes (8AM-12:00PM, 1-5:00PM, or 6:00PM and after).

We will do our best to accommodate pick up and drop off times; however, we are dependent on our volunteers.

Refer to the OWC/Trailer you selected to view it's calendar for availability here: AAW Equipment. Although you are requesting from a certain location, the equipment may already be checked out but not on the calendar yet. In that case we will contact you.

Special Note for Deer Hunting (Rifle/Muzzleloader Seasons): Reservations will be limited to either the first half or the second half of the hunting season, e.g. Friday to Wednesday, or Wednesday to Monday.
CHECKOUT: Select your preferred checkout date and time.*
CHECKIN: Select your preferred checkin date and time.*
Please select a checkin date/time that is after your checkout date/time.
Additional Equipment Options (check all you are requesting):

Seatbelt ExtenderAttendant ControlOther
Specify any special needs required for the success of equipment usage:
Deposit Paid
Month in text

Client Contact Information
Who will use the adaptive equipment:*

AdultMinor
First Name*
Last Name*
AAW ID #
Membership Level
Email*
example@example.com
Phone
Please enter a valid phone number.
Kind of phone*

mobilehomeworkOther
Emergency Contact
Emergency Contact First Name*
Emergency Contact Last Name*
Emergency Contact Phone *
Please enter a valid phone number.
Relationship to Member*
Example: Emergency Contact is the Subscriber's _____
AAW Use Agreement and Waiver and Release of Liabilty (Link)
Signature

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Reservation ID #
This will autofill based on the information inputted into this form.
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
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
Rock CO/CI Email
example@example.com
Who - checkout/in?
example@example.com
Checkout date and time calculations & prefill

MonthDayYear
Date
Hour MinutesAM/PM Option
Checkin date and time for calculations & prefill

MonthDayYear
Date
Hour MinutesAM/PM Option
AAW Team - this is a hidden field
Reply to email - this is a hidden field
example@example.com
AAW Admin email
example@example.com
AAW Reservations
Today's date

MonthDayYear
Date
Date to initiate checkout form

MonthDayYear
Date
Date to initiate checkin form

MonthDayYear
Date
Should be Empty:

AAW Reservation Request: Additional Information

Client Contact Information

Emergency Contact