Go Baby Go - Child Development Center of Natrona County

Go Baby Go Wyo modifies battery-operated ride-on cars to give children with mobility impairments an opportunity to access play, exploration, and social encounters.

This application can be completed by parents/guardians or therapists who would like to refer a child to receive a Go Baby Go Wyo car.

Child's Name(Required)

Child's date of birth(Required)

Child's height (in) and weight (lb)(Required)

Nature of child's disability or diagnosis(Required)

Can your child sit independently? Does your child lean to the side in sitting? Can your child keep head up when sitting?(Required)

Does your child have difficulty reaching, using hands or arms? Does your child have weakness on one side?(Required)

What equipment does your child need? (oxygen, braces, ventilator, etc.)(Required)

Does your child use augmentative and alternative communication (AAC) or a speech generating device (SGD)? If so, please provide details regarding the communication system being used.(Required)

Do you have concerns about your child's vision? If yes, please explain:(Required)

What are your child's favorite colors? Characters?(Required)

Where will your child use a GoBabyGo Wyo car? (home, school, work, etc.)(Required)

Will you be able to take care of a GoBabyGo Wyo car by recharging the battery and storing it in a safe place when not in use?(Required)

What concerns do you have about your child operating a ride-on car?(Required)

How does your child move around their environment now?(Required)

How did you hear about us?(Required)

Parent/Guardian name(Required)

Phone number(Required)

Address(Required)

Therapist's name and/or name of clinic your child attends:(Required)

Provide name and contact of therapist that can currently provide information about specific mobility needs/challenges of your child:(Required)

Consent(Required)

I agree

By submitting this application, I give permission for GoBabyGo Wyo to contact the therapists/services providers listed. This will help GoBabyGo Wyo customize the car for my child.

This field is for validation purposes and should be left unchanged.

Sponsor a Go Baby Go Car!