• Ready, Set, Walk Interest Form

  • Thank you for your interest in Ready, Set, Walk! This program is a partnership between Easterseals Superior California and California State University, Sacramento (Sacramento State). It brings together experienced pediatric therapists and future physical therapists to help young children build walking skills through supported treadmill practice and evidence-based care.

    To be eligible, children must be 5 years old or younger and weigh 70 pounds or less (due to the limits of the treadmill).

    Please fill out the form below. It takes about 5 minutes. A member of our team will reach out within 5 business days to talk about next steps. Questions? Email us at pedsadministration@myeasterseals.org.

  • About You

  • Relationship to child*
  • Format: (000) 000-0000.
  • Preferred way to contact you*
  • Preferred language

  • About Your Child

  • Child's date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • How does your child move around right now?*
  • Has your child ever done body-weight-supported treadmill training? This is when a child walks on a treadmill while wearing a harness that supports part of their weight.*

  • Current Services

  • Is your child currently receiving physical therapy?*
  • Is your child a client of Alta California Regional Center (ACRC)?*
  • How old is your child?
  • How does Alta California Regional Center fund your child's services?
  • Does your child take part in any recreation activities paid for by Alta California Regional Center?

  • SECTION 4: WRAP-UP

  • Which days generally work best for appointments?*
  • What times of day work best?*
  • How did you hear about Ready, Set, Walk?
  • Would you be interested in participation in a research project as part of your participation in the RSW program?
  • Thank you! We're excited to learn more about your child and will be in touch within 5 business days. If you have questions in the meantime, please email us at earlystartservices@myeasterseals.org.
  • Should be Empty: