Equipment Loan Application

The Equipment Loan Program provides access to equipment for eligible members of Wheelchair Sports NSW/ACT (WSNSWACT).

The program supports participants to try sports delivered by WSNSWACT, develop skills, and engage in training and competition by reducing barriers to accessing disability sporting equipment.

Please complete this application form to help us assess your equipment needs and suitability for the program.

*Required field

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Select your age range*

Select your gender identity*

Male

Female

Non-Binary

Differently identify

Enter your post code*

Enter your email address*

Participant Information

Full name of hirer.*

Do you intend to hire this equipment for yourself, or on behalf of another?*

Please describe your disability.*

Having a clear understanding of your disability will help us determine suitability for certain equipment.

Sport and Intended Use

What type of equipment would you like to hire?*

Which sport will the equipment primarily be used for?*

What is your level of experience in the sport?*

How often will you use the chair?*

Where will the equipment primarily be used?*

Where will the equipment primarily be stored?*

Please provide a specific address.

Current Equipment

Are you a full-time wheelchair user?*

A full-time wheelchair user is classified as someone who relies on a wheelchair as their primary or exclusive means of mobility to navigate daily life.

Have you previously used a sports/racing chair?*

Body Measurements

Hip width / widest point while seated.*

Waist width / widest point while seated.*

Buttock-to-knee length (upper leg length).*

Lower leg length (knee to heel).*

Shoulder width.

Seated shoulder height.

Seated torso height.

Arm length / reach.

Chest circumference

Preferred seat angle / posture.

Preferred back support.

Functional & Physical Requirements

Do you have any physical considerations that may affect chair setup?

Do you require any of the following?

Any pain, pressure areas, or comfort concerns we should know about?

Logistics & Loan Management

Are you able to visit our office in Putney NSW for a test fitting?*

A test fitting ensures we have a suitable chair for you prior to delivery.

Preferred delivery location.*

Please provide a specific address, or WSNSWACT club name.

Are you able to transport the chair?*

WSNSWACT are able to bring the chair to you for initial delivery, but transport for the duration of the loan will solely be the responsibility of the hirer.

Loan duration requested.*

Equipment is typically loaned out at a rate of $250/6 months.