Apply for a wheelchair costume or walker costume

Request a Costume from the Blue Ridge Region Chapter of Walkin' & Rollin' Costumes

We would love to be able to fulfill every request that came in from around the world. However, until such time that we have enough volunteers, availability and funding to do so, requests will go through an application process.

Walkin' & Rollin' Costumes will review every application and try and build every costume requested; however, please note, we are not always able to complete every request. Submitting a costume request does not guarantee a costume. Costumes take weeks to months to build and assemble. The earlier you submit your request, the better.

We are now accepting requests for costumes year round, but please NOTE: these costumes can take up to 3 months to build.

To be eligible for a costume from Walkin' & Rollin' Costumes, the child must be between the ages of 3 and 17 and primarily uses a walker or wheelchair. By submitting an application, you agree to the terms and conditions.

Request a Costume from Walkin' & Rollin' Costumes, Blue Ridge Region

* Indicates required field

Parent/Guardian Name *

First

Last

Child's Name *

First

Last

Child's Age *

Email *

Phone Number *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Tell us a little about the child *

What costume(s) would the child like? *

Is this costume from a television show, movie, comic, etc? If so, please explain. *

How did you hear about Walkin’ & Rollin’ Costumes? *

Is there a specific date or event, for when the child would need the costume? *

This next section is about the equipment we would be building the costume around:

What type of equipment will the costume go around? *

Walker Manual Wheelchair Motorized Wheelchair

What brand/make/model is the walker or wheelchair? *

These questions are for a wheelchair only:

Can the child drive themselves? *

Yes No

do you need access to the parent handles in the back? *

Yes No

Upload photos of the child in their walker/wheelchair from each side (front, left side, right side, and back)
This helps us determine what measurements we will need and where we can attach the costume to the special needs equipment. Please try and use a simple background like a blank wall to help us see the details of the equipment.

Upload Photo of Front *

Max file size: 20MB

Upload Photo of Left Side *

Max file size: 20MB

Upload Photo of Back *

Max file size: 20MB

Upload Photo of Right Side *

Max file size: 20MB

Submit

​​Application

Request a Costume from the Blue Ridge Region Chapter of Walkin' & Rollin' Costumes

Request a Costume from Walkin' & Rollin' Costumes, Blue Ridge Region

Application