Magic Wheelchair

Apply for an Epic Costume

Part 1: Provide Your Information

* First Name

* Last Name

* Email

* Phone

* Your relationship to the kiddo (parent, guardian, teacher, friend, etc):

How did you hear about Magic Wheelchair?

Part 2: About the Kiddo

* Kiddo's Name

* Kiddo's Age

* Tell us a little about the kiddo:

* What costume(s) would this kiddo like?

Address

* City

* State

* Postal Code

Country

Is there a specific date or event that the child would need the costume for? Note that it takes a minimum of THREE MONTHS to complete a costume.

Part 3: Photo/Video of Kiddo (optional)

Upload a photo or video of the kiddo so that we can get to know him/her better.

To upload video, click on "Upload Photo" below, then select "All File Types" from the "Format" dropdown menu.

Photo