Children's Assistive Technology Service (C.A.T.S.)

Release Form

Please read all the conditions below before signing the Equipment Release Form.

1. Who CATS serves?

C.A.T.S. serves children and adolescents with physical and developmental disabilities who need assistive technology to assist with movement, positioning, behavior, or communication. The children we serve typically have neuromuscular and orthopedic disorders that impair function.

2. Where does CATS operate?

CATS is a Virginia nonprofit corporation serving individuals who reside or receive rehabilitative or medical services in Virginia.

3. Type of equipment accepted for re-use

  • CATS accepts donations of gently used assistive technology in pediatric sizes, including walkers, gait trainers, standing frames, wheelchairs, activity chairs or other adaptive seating, pediatric therapy equipment, mobile patient lifts, bath and shower chairs, toilet chairs, positioning wedges, adaptive recreation equipment, accessibility switches and basic augmentative communication devices.
  • CATS does not accept adult sized equipment, child safety restraints (car seats), beds, life support devices and medical supplies.
  • CATS may refuse to accept equipment.

4. Referrals

Equipment must be requested by the child’s legal guardian and must include the name and contact information for the referring physician, therapist, or educational team. All equipment requests must be made on-line at the CATS website and must include a completed CATS Request form, a completed and signed CATS Release of Liability form, and a completed and signed CATS Release of Medical Information form authorizing the child’s referring healthcare professional to release medical information to CATS.

5. How Equipment is Issued

  • CATS sends automated responses via email to equipment requests. If the requester does not reply to CATS within 5 days, the equipment will be put back into inventory.
  • The family, caregiver or designated individual can pick up adaptive equipment from CATS. Adaptive equipment is defined as equipment that does not need fitting or customization.  Examples include bath chairs, wedges, activity chairs, medical umbrella strollers.
  • Rehab equipment may also be picked up from CATS by the family, caregiver, or designated individual, but requires fitting, customization, or adjustments by the referring medical professional. Referral to an Assistive Technology Professional or Durable Medical Equipment vendor may be necessary.  The fitting or customization must be arranged by the responsible party ordering the equipment. Examples of rehab equipment include manual or power wheelchairs with adaptive seating systems, standers, and gait trainers/walkers.
  • Once a pick-up date has been agreed upon, the requester must comply or notify CATS immediately about rescheduling. If the equipment is not picked up or rescheduled, it will be returned to inventory.
  • A CATS Equipment Receipt form must be signed when equipment is picked up.

6. Limitations of Services

  • CATS does not warrant equipment or provide repair services. CATS can provide the family with contact information for local vendors that provide repair services.
  • A child may receive up to 3 pieces of equipment through CATS in a calendar year.
  • Requested equipment must serve a child’s immediate needs.  CATS does not supply devices for future needs.
  • Equipment is provided from available inventory. CATS does not maintain a “wish list” or “wait list” for equipment.
  • CATS does not deliver donated equipment to families. The family must arrange for pick-up of the equipment.

7. Use of Equipment

All equipment donated by CATS is for the purpose of serving an individual’s immediate assistive technology need.  Ownership of the equipment transfers to the child and caregiver.   However, sale of donated equipment by the caregiver is prohibited by the terms and intent of this agreement.

8. Equipment Waiver of Liability Form

I understand and agree to the following:

  • Any and all durable medical equipment I receive from CATS is non-prescriptive and is free of charge.
  • CATS does not warrant in any way the condition of any equipment i receive from CATS.
  • By signing this form, I agree to consult the user’s physician, physical therapist, occupational therapist, or speech-language pathologist (healthcare provider) that I listed above regarding the suitability and the fit of all equipment that I receive from CATS prior to its use and to follow all healthcare provider’s directions for use.
  • I give permission for CATS staff to discuss the requested equipment with my child’s healthcare provider.
  • I understand that CATS does not warrant that any equipment I receive from CATS is safe or suitable for any individual.
  • I am responsible for checking to determine if any equipment I receive from CATS is covered under the manufacturer’s warranty.
  • CATS is not aware of any Federal Food and Drug Administration (FDA) recall on any equipment that I receive from CATS, however, I will check to see if the equipment has been recalled by the FDA by going to the website: https://www.fda.gov/medical-devices/medical-device-safety/medical-device-recalls.
  • I am responsible for all repair or maintenance of all equipment that I receive from CATS.
  • If the equipment I request is part of the CATS Communication Loan Library:
    • I understand that this equipment is provided as a loan for up to a three-month time period. I agree to return this device to CATS in good working condition.  If I fail to return the equipment as agreed, I agree to pay for the replacement cost of this device plus shipping and handling. 
  • I hereby release and hold harmless CATS, its personnel and all persons acting on its behalf from all claims by me or my child, or any person(s) acting on my behalf or my child’s behalf for any loss, personal injury, liability, expense or damage, including, but not limited to general, specific, incidental, or consequential damages of any kind or nature whatsoever arising from the receipt or use of this equipment

All equipment requires a fully completed Release Form.

You MUST complete this Release Form online before your order is processed.

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Signature Certificate
Document name: Equipment Release Form
lock iconUnique Document ID: f7c1690823f9021a9f96c8a45f31fdd71ff94cf9
Timestamp Audit
September 9, 2021 10:03 pm EDTEquipment Release Form Uploaded by CATS Administration - [email protected] IP 70.160.150.88
August 29, 2022 3:05 pm EDTJohn Naples - [email protected] added by CATS Administration - [email protected] as a CC'd Recipient Ip: 70.160.150.88
August 29, 2022 3:05 pm EDTBeth Beach - [email protected] added by CATS Administration - [email protected] as a CC'd Recipient Ip: 70.160.150.88
August 29, 2022 3:05 pm EDTGardner Umbarger - [email protected] added by CATS Administration - [email protected] as a CC'd Recipient Ip: 70.160.150.88
August 31, 2022 7:22 pm EDTJohn Naples - [email protected] added by CATS Administration - [email protected] as a CC'd Recipient Ip: 2600:8805:1925:9300:d596:bc2f:9b30:cb0b
August 31, 2022 7:22 pm EDTBeth Beach - [email protected] added by CATS Administration - [email protected]icesforkids.org as a CC'd Recipient Ip: 2600:8805:1925:9300:d596:bc2f:9b30:cb0b
August 31, 2022 7:22 pm EDTGardner Umbarger - [email protected] added by CATS Administration - [email protected] as a CC'd Recipient Ip: 2600:8805:1925:9300:d596:bc2f:9b30:cb0b
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