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Physical and occupational therapy

Apply for a Go Baby Go! car in Fox Valley

Who may qualify for a car?

  • A child between 9 months and 5 years of age who has difficulty independently moving through space.
  • Diagnoses may include: Cerebral Palsy, Spina Bifida, Genetic Syndromes, Down Syndrome, Congenital Heart Defect, Prematurity, Autism, and other neurologic or orthopedic conditions.
  • It is ideal for the child to have sufficient head control and to be at least working toward independent sitting.
  • If the child has seizures, it is ideal that the seizures are well-controlled.

What is the commitment asked of the family?

  • Complete the family application
  • Attend a 30-minute fitting with your child at a designated FVTC or Children’s Wisconsin location.
  • Pick up the car from  FVTC approximately 4 weeks after the initial fitting. Your child does not have to be present for the pick-up.
  • Very safely and closely accompany your child as the car is utilized in a controlled environment.

What benefits might you expect from your child using a car?

  • Increased opportunities for language and socialization
  • Improved exploration of the environment
  • Increased qualify of life and well-being for the child
  • Reduced caregiver burden
  • Increased sense of independence and initiation skills
  • Improvement in motor and cognitive skills
  • Improved participation in play with siblings/peers

Do you have a child that needs a car?

Fill out the form below and one of our therapists will be in touch with you within two weeks.

Demographics

Current rehabilitation services

Home environment

Child’s characteristics and abilities

I authorize Children’s Wisconsin (“Children’s”) to disclose this form, and to discuss my child’s medical information, to/with Fox Valley Technical College (“FVTC”) for consideration of my child’s participation in the Go Baby Go program. If my child meets the criteria for the program, a therapist and FVTC will further evaluate and fit my child for a motorized car modified by FVTC. I understand the following:

• I may revoke this authorization by sending written notice to gobabygofoxvalley@childrenswi.org.

• My child may not be able to participate in the Go Baby Go program if this authorization is revoked.

• The failure to sign this authorization or to participate in the Go Baby Go program will not impact my child’s treatment, payment or participation in other Children’s programs.

• Children’s is not responsible for the further disclosure of my child’s medical information by FVTC or any subsequent recipients of my child’s medical information.

• This authorization is valid for one year, or until my child’s participation in this program ends, whichever occurs sooner.

I have read this information. I am legally able to consent for my child. By signing this form, I give my permission and agree to the terms listed above.
Contact us

If you have questions about the Go Baby Go! program, please email:

Milwaukee: gobabygomilwaukee@childrenswi.org

Fox Valley: gobabygofoxvalley@childrenswi.org